Heartburn - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

HEARTBURN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. ...

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HEARTBURN A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Heartburn: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83976-X 1. Heartburn-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on heartburn. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HEARTBURN.............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Heartburn ................................................................................... 10 E-Journals: PubMed Central ....................................................................................................... 15 The National Library of Medicine: PubMed ................................................................................ 16 CHAPTER 2. NUTRITION AND HEARTBURN .................................................................................... 37 Overview...................................................................................................................................... 37 Finding Nutrition Studies on Heartburn .................................................................................... 37 Federal Resources on Nutrition ................................................................................................... 39 Additional Web Resources ........................................................................................................... 39 CHAPTER 3. ALTERNATIVE MEDICINE AND HEARTBURN ............................................................. 43 Overview...................................................................................................................................... 43 National Center for Complementary and Alternative Medicine.................................................. 43 Additional Web Resources ........................................................................................................... 47 General References ....................................................................................................................... 55 CHAPTER 4. PATENTS ON HEARTBURN .......................................................................................... 57 Overview...................................................................................................................................... 57 Patents on Heartburn .................................................................................................................. 57 Patent Applications on Heartburn............................................................................................... 71 Keeping Current .......................................................................................................................... 77 CHAPTER 5. BOOKS ON HEARTBURN .............................................................................................. 79 Overview...................................................................................................................................... 79 Book Summaries: Federal Agencies.............................................................................................. 79 Book Summaries: Online Booksellers........................................................................................... 81 The National Library of Medicine Book Index ............................................................................. 84 Chapters on Heartburn ................................................................................................................ 84 CHAPTER 6. MULTIMEDIA ON HEARTBURN ................................................................................... 87 Overview...................................................................................................................................... 87 Video Recordings ......................................................................................................................... 87 Bibliography: Multimedia on Heartburn ..................................................................................... 89 CHAPTER 7. PERIODICALS AND NEWS ON HEARTBURN ................................................................ 91 Overview...................................................................................................................................... 91 News Services and Press Releases................................................................................................ 91 Newsletters on Heartburn............................................................................................................ 93 Newsletter Articles ...................................................................................................................... 94 Academic Periodicals covering Heartburn................................................................................... 95 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................... 97 Overview...................................................................................................................................... 97 U.S. Pharmacopeia....................................................................................................................... 97 Commercial Databases ................................................................................................................. 98 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 103 Overview.................................................................................................................................... 103 NIH Guidelines.......................................................................................................................... 103 NIH Databases........................................................................................................................... 105 Other Commercial Databases..................................................................................................... 107 APPENDIX B. PATIENT RESOURCES ............................................................................................... 109 Overview.................................................................................................................................... 109 Patient Guideline Sources.......................................................................................................... 109 Finding Associations.................................................................................................................. 119

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APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 121 Overview.................................................................................................................................... 121 Preparation................................................................................................................................. 121 Finding a Local Medical Library................................................................................................ 121 Medical Libraries in the U.S. and Canada ................................................................................. 121 ONLINE GLOSSARIES................................................................................................................ 127 Online Dictionary Directories ................................................................................................... 128 HEARTBURN DICTIONARY ..................................................................................................... 129 INDEX .............................................................................................................................................. 167

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with heartburn is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about heartburn, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to heartburn, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on heartburn. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to heartburn, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on heartburn. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON HEARTBURN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on heartburn.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and heartburn, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “heartburn” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Low-Dose Ranitidine for the Relief of Heartburn Source: Alimentary Pharmacology and Therapeutics. 13(4): 459-465. April 1999. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Approximately 30 percent of adults in the United States suffer from heartburn and related symptoms monthly; more than 20 percent of these people experience heartburn at least once per day. Although many rely on self medication with antacids for the relief of their symptoms, treatments that decrease gastric volume as well as increase the pH of refluxed material should be more effective in relieving heartburn. This article reports on a study undertaken to compare the safety and efficacy of low

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dose regimens of ranitidine for the relief of heartburn. Adults with at least a 3 month history of heartburn were eligible for this randomized, double blind, parallel group, multicenter dose ranging study. Following a 1 week open label run in phase to document baseline heartburn frequency, subjects were randomized to receive treatment with one tablet of either ranitidine 75 mg (n = 491), ranitidine 25 mg (n = 504), or placebo (n = 494), to be taken as needed up to four times daily for 2 weeks for the relief of heartburn. The ranitidine 75 mg (Zantac 75) regimen was clinically and statistically more effective than placebo for all measures in relieving heartburn and reducing antacid consumption. In addition, the ranitidine 75 mg regimen was superior to placebo in providing heartburn relief within 30 minutes of dosing that lasted for up to 12 hours. Ranitidine 25 mg was observed to be statistically superior but not clinically different from placebo, as defined a priori, in providing heartburn relief. All treatments were well tolerated and adverse events occurred no more frequently with the ranitidine regimens than with placebo. No clinically significant drug interactions with ranitidine were observed in this study. The authors note that the issue of drug interactions is especially important for products made available over the counter because of the potential for exposure to dangerous interactions that may occur in the absence of oversight by health care professionals. 1 figure. 1 table. 12 references. •

Clinical Effectiveness of a New Antacid Chewing Gum on Heartburn and Oesophageal pH control Source: Alimentary Pharmacology and Therapeutics. 16(12): 2029-2035. December 2002. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Esophageal acid neutralization with antacids depends on the duration of esophageal antacid exposure and acid neutralizing capacity. A gum that releases antacid as it is chewed could take advantage of both mechanisms to enhance heartburn relief. This article reports on a crossover study of 24 patients who underwent four regimens: placebo, chewable antacid tablets, lower dose antacid gum, and higher dose gum. A dual pH probe was placed, subjects ate a standardized provocative meal, and self-dosed once as needed. Both gums decreased heartburn compared to placebo for 120 minutes. Higher dose gum decreased heartburn more than chewable antacids up to 120 minutes post-dose. Active chewable antacid and gums immediately increased esophageal pH, with significant improvement 15 to 30 minutes post-dose. The authors conclude that calcium carbonate gum effectively neutralizes esophageal acidity and relieves symptoms following a meal, and is superior to chewable antacids in terms of the duration of heartburn relief. 5 figures. 7 references.

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Practical Pointers for Grappling with GERD: Heartburn Gnaws at Quality of Life for Many Patients Source: Postgraduate Medicine. 105(7): 88-90, 95-98, 103-104. June 1999. Summary: Gastroesophageal reflux disease (GERD) seriously impairs quality of life for millions of people and consumes huge amounts of medical resources. The typical symptoms of heartburn and acid regurgitation are considered reasonably specific for GERD, but the exact mechanisms involved in causing these symptoms are still not clear. In this article, the first in a series of three on esophageal diseases, the authors review the current concepts about the causes, recognition, and treatment of this disorder. The spectrum of disease due to GERD is wide, ranging from symptoms alone to esophagitis,

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Barrett's esophagus, and respiratory tract complications. The primary cause of symptoms and tissue injury to the esophagus associated with GERD is duration of esophageal exposure to gastric acid and other digestive juices. A number of tests facilitate diagnosis of GERD and its complications, but no single test currently provides all the information necessary for definitive evaluation in patients with complicated symptoms. Treatment options include lifestyle modification, antacids, histamine antagonists, proton pump inhibitors, promotility drugs, and antireflux surgery. Recommended lifestyle changes include the following: stop smoking; lose excess weight; eat small meals; reduce consumption of caffeine, chocolate, fatty foods, alcohol, onions, peppermint, and spearmint; elevate the head of the bed (6 to 9 inches), and avoid tight fitting garments. Medications can relieve symptoms and heal even the most severe forms of esophagitis. Surgical therapy is an effective option for patients with truly refractory disease or for those patients with significant disease who prefer not to use drug treatment. 3 figures. 3 tables. 16 references. •

Hazards of Heartburn Source: Current Topics in Gastroenterology. March 1992. p. 1. Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. (703) 549-4440. Summary: Heartburn is a common problem that many people believe to be of minor significance. This brief article reports on the serious complications that can accompany heartburn. The article reports on a survey of 1,190 people who were interviewed to identify the scope of this problem. The article discusses the results of the survey, including the effects of heartburn on quality of life. The author notes that improperly treated acid reflux may progress to more serious conditions such as ulcers, bleeding, strictures, and cancer of the esophagus. The article concludes that all people with heartburn should consult a health care practitioner about the problem.

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When Heartburn Turns Serious Source: Digestive Health and Nutrition. p. 18, 20-21. May-June 2002. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: This article explains how heartburn can sometimes be a serious symptom that needs to be treated, in order to avoid complications, including a negative impact on one's lifestyle and higher risk for Barrett's esophagus and esophageal cancer. Before 1999, heartburn was considered mostly a nuisance to the person with heartburn. But in 1999, a study was published that reported a link between heartburn and esophageal cancer. The risk was greater the longer, more severe, and more frequent the heartburn. Approximately 10 to 15 percent of people with heartburn develop Barrett's esophagus, which is defined by the presence of abnormal and precancerous tissue in the esophageal lining. Doctores usually recommend that patients with Barrett's be monitored with upper gastrointestinal (GI) endoscopy and biopsies. The author reiterates the importance of having heartburn diagnosed and treated. Treatment options discussed include lifestyle changes, medication, and surgery. The article concludes with five web sites for readers who wish to find more information.

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Gastroesophageal Reflux Disease: Under the Surface of Heartburn Lies a Potentially Serious Disease Source: AJN. American Journal of Nursing. 100(9): 24D, 24F, 24H. September 2000. Contact: Available from Lippincott Williams and Wilkins. AJN, P.O. Box 50480, Boulder, CO 80322-0480. (800) 627-0484 or (303) 604-1464. Summary: This article familiarizes nurses with gastroesophageal reflux disease (GERD), a potentially serious disease that can be the cause of many patient's symptoms of heartburn. Heartburn is the most common symptom of GERD, which is caused by a weakened or inappropriately relaxed lower esophageal sphincter (the ring of muscle between the stomach and the esophagus). GERD is the most prevalent of the acid related disorders, which also include dyspepsia, gastritis, and peptic ulcer disease. The primary symptom of GERD is heartburn, which typically occur two to three hours after ingestion of a large or fatty meal or when lying down. When the gastric acid is in contact with the esophagus repeatedly or for long periods of time, the esophagus can become damaged and irritated; this can also cause the development of precancerous cells. A careful history can help differentiate between cardiac chest pain, panic attacks, other sources of esophagitis, and GERD. Diagnostic tests can include barium swallow test, esophageal manometry or esophageal pH, esophagoscopy, and the Bernstein test. These diagnostic studies assess esophageal motility (movement of contents through the esophagus), clearance, and the causes of gastroesophageal reflux. Treatment goals for patients with GERD are to eliminate the symptoms, decrease the reflux, and make the refluxed material less irritating to the esophagus. Treatment includes dietary and lifestyle changes, drug therapy, and sometimes surgery. 1 figure. 15 references.

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Chronic Heartburn, Asthma, Cancer, and Laryngitis are Linked to GERD Source: Practical Gastroenterology. 21(12): 35-38, 40-41. December 1997. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article presents a symposium in which participants discuss the links between gastroesophageal reflux disease (GERD) and the seemingly unrelated conditions of asthma, laryngitis, and some forms of cancer. GERD is in itself a potentially serious problem whose primary symptom is chronic heartburn. GERD affects some 19 million Americans and when untreated may be a precursor to Barrett's esophagus and esophageal cancer. This symposium was called in response to a marked increase in the incidence of Barrett's esophagus and the fact that cancer of the esophagus is one of the more lethal cancers. Topics include a description of GERD, the objectives for gastroenterologists in this area, the physiology of the lower esophageal sphincter (LES), the role of hiatal hernia, the role of transient LES relaxation, delayed gastric emptying, stricture formation, Barrett's esophagus and the related mucosal changes, treating reflux disease (diet therapy, lifestyle changes, and reducing drug effects), the role of self care, and working with a physician for drug therapy. The authors note that lifestyle changes, followed strictly, can eliminate the symptoms of GERD in about 20 percent of cases. However, for most patients with GERD, self care measures are insufficient to treat the disease fully. The authors conclude with a brief description of the current drugs used to treat GERD. 3 figures.

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Rx for People Who Take Heartburn or Ulcer Drugs Source: Tufts University Diet and Nutrition Letter. 10(1): 1-2. March 1992.

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Summary: This article reports on a study that investigated the effects of alcohol in people who are taking drugs that control excess stomach acid. Researchers at the Bronx Veterans Affairs Medical Center in New York observed a group of men and women who were given alcohol after a week of taking Tagamet (cimetidine) or Zantac (ranitidine). In people taking Zantac, the blood alcohol level climbed 33 percent higher than would be expected from their alcohol intake; Tagamet users experienced a 100 increase in their blood alcohol levels. Researchers speculate that the drugs may inhibit the activity of an enzyme in the body that breaks down some of the alcohol taken in before it has a chance to enter the bloodstream. •

Heartburn: Community Perceptions Source: Journal of Gastroenterology and Hepatology. 15(1): 35-39. January 2000. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail: [email protected]. Website: www.blackwell-science.com. Summary: This article reports on a study undertaken to determine the prevalence of heartburn in the Australian community, and document factors precipitating it and medications used in treatment. Telephone interviews with 1,200 individuals aged 18 years or more were conducted one weekend in 1996. Each respondent was asked four questions about heartburn, its severity, factors causing it, and current therapy. Fifty-six percent of respondents reported that they had suffered from heartburn at some time in the past and 37 percent had symptoms at least once every 4 to 6 months. The frequency of heartburn increased with age and was more common in men (40.7 percent) than women (32.6 percent). There was no difference in frequency between city and rural dwellers, or between white and blue collar workers. Almost half the individuals experienced mild pain or discomfort, one third had moderate discomfort, and 15 percent reported severe pain or discomfort. Women were more likely to report greater problems than men. Aggravating factors included spicy foods, greasy or risk foods, stress, alcohol, overeating, pregnancy, smoking, food allergy, and coffee. More than half the respondents relied on antacids to control symptoms, 20 percent used prescription medications, and a similar number did not use any medication. The authors conclude that heartburn is common in the Australian community and sufferers attribute symptoms to various lifestyle events, including diet and stress. Antacid usage is the most common mode of therapy. 4 tables. 18 references.

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Dousing Your Heartburn Source: Healthline. p. 15. November-December 2000. Contact: Available from Sickbay Health Media, Inc. Healthline, 510 Broadhollow Road, Suite 300, Belville, NY 11747. (631) 694-0040. Fax (631) 694-2234. Website: www.healthline.com. Summary: This article reviews strategies to treat heartburn, the burning sensation behind the breastbone, often accompanied by a sour taste in the back of the mouth. Heartburn is the result of stomach acid flowing up into the esophagus (gastroesophageal reflux). Frequent heartburn is called gastroesophageal reflux disease (GERD); people with GERD may also experience nausea, sore throat, hoarseness, wheezing, and a cough. The article reviews the causes and incidence of gastroesophageal reflux disease (GERD), and summarizes the levels of treatment. Risk factors for GERD include being over 65 years of age, use of certain medications, obesity, pregnancy, a high fat diet, and use of caffeine, alcohol, or tobacco. Most people with

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GERD have a mild disease and a low risk for long term complications. However, untreated, GERD can lead to inflammation of the esophagus (esophagitis) or to a precancerous condition called Barrett's esophagus. The article focuses on behavioral strategies to help prevent heartburn: control weight, avoid foods or beverages that can trigger heartburn, minimize fat in the diet, avoid lying down for 2 hours after eating, do not smoke, and do not drink alcohol. Drug therapy can include nonprescription drugs such as antacids and H2 blockers, then prescription medications such as stronger H2 blockers and proton pump inhibitors. Finally, surgery to improve the functioning of the muscular valve between the stomach and the esophagus may be required in the worst cases. •

Heartburn: When a Little Indigestion Becomes a Big Problem Source: Mayo Clinic Health Letter. 13: 1: 1-3. January 1995. Summary: This article reviews the problem of heartburn, the most common symptom of gastroesophageal reflux disease (GERD). The article summarizes lifestyle habits that may contribute to or cause GERD. The article also provides information about the physiology of the stomach and esophagus; factors that can relax the esophageal sphincter muscle, including obesity, certain foods and beverages, large meals, and lying down after meals; how to know when symptoms dictate a visit to one's health care provider; diagnostic tests; complications; and drug therapy, including H2 blockers, omeprazole, and cisapride. One sidebar briefly reports on surgical options for GERD. 1 figure.

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Dyspepsia and Heartburn Source: Rheumatic Disease Clinics of North America. 25(3): 703-718. August 1999. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article, from a series on the general medical care of the patient with rheumatic disease, reviews dyspepsia and heartburn. For each condition, the authors discuss a definition, epidemiology, causes, and management. The article includes two algorithms that illustrate a general approach to patients with dyspepsia and heartburn. The initial consultation should always include screening for alarm symptoms. If alarm symptoms are present, then the patient should be referred for an immediate endoscopy, regardless of whether the presenting symptom is dyspepsia or heartburn. In the absence of alarm symptoms, Helicobacter pylori status should be checked in patients with dyspepsia. If the patient is H. pylori negative, then an empiric course of treatment with a histamine H2 receptor antagonist can be tried for 4 to 6 weeks. Treatment can be alternated with prokinetic agents such as cisapride. If symptoms persist, then the patient should be referred for an endoscopy. If the patient is H. pylori positive, empiric antibiotic therapy should be instituted to reduce the ulcer pool. Patients who fail to respond or who have recurrence may have either persistent H. pylori infection (which can be confirmed by urea breath test) or another cause for their dyspepsia. These patients should then be considered for an endoscopy. In the absence of alarm symptoms, patients presenting with persistent heartburn should be given a trial of histamine H2 receptor antagonists, along with advice on lifestyle modifications. If symptoms do not respond, then proton pump inhibitors (PPIs) should be started. If the response continues to be suboptimal, the patient should be referred to a specialist for further workup, which can include endoscopy, a 24 hour ambulatory esophageal pH study to confirm gastroesophageal reflux disease or assess the degree of response to

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treatment, and esophageal manometry if scleroderma is suspected or surgery is contemplated. 2 figures. 106 references. •

Heartburn: Origins and Cures Source: Newsletter for People with Lactose Intolerance and Milk Allergy. 1992. p. 2-3. Contact: Available from Newsletter for People with Lactose Intolerance and Milk Allergy. P.O. Box 3129, Ann Arbor, MI 48106-3129. (313) 572-9134. Summary: This brief article reviews common myths and facts about heartburn, its causes, and treatments. After a quick review of the sphincter mechanism, the author lists situations that will contribute to heartburn, including eating too much food at one sitting, wearing tight clothing, being overweight, lying down after eating, and smoking. The article emphasizes treating the symptoms of heartburn as well as changing the quality of lifestyle in ways that may reduce the risk of heartburn.

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Heartburn and Reflux Oesophagitis (editorial) Source: Journal of Gastroenterology and Hepatology. 15(1): 1-2. January 2000. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail: [email protected]. Website: www.blackwell-science.com. Summary: This editorial comments on an accompanying article about heartburn and reflux esophagitis in a population in Australia. The authors disagree with some of the researchers' definitions, particularly as the study equates heartburn with gastroesophageal reflux disease (GERD). The editorial authors, however, agree that there is a high prevalence of dyspepsia in the Australian community and GERD is a large contributory component. The editorial than addresses some of the implications that result from this conclusion. Topics covered include symptomless reflux, cancer of the esophagus, Barrett's esophagus and reflux, and the use of antisecretory drugs to prevent the complications of esophageal reflux. The editorial comments on a major clinical and epidemiological puzzle in this arena: an epidemic of adenocarcinoma of the lower third of the esophagus has developed. This epidemic began just before the introduction of proton pump inhibitor drugs, which are a major means of managing the symptoms of reflux disease. There is no proof of the linkage involved or whether aggressive management of GERD is of more than symptomatic benefit. The authors call for more and better epidemiological studies into the mysteries of reflux and its complications. 9 references.

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Gastroesophageal Reflux Disease: Gaining Control Over Heartburn Source: Postgraduate Medicine. 101(2): 181-182, 185-187. February 1997. Summary: This is the first in a series of short articles on management of common complaints primary care physicians encounter in the office setting. In this article, the author focuses on gastroesophageal reflux disease (GERD). His article includes a summary of the current standard of care, a flowchart of the patient workup, and an information sheet that can be copied and distributed to patients. Topics include the etiology of GERD, symptoms, diagnosis, and drug therapy. Symptoms of reflux, such as heartburn, are due to a combination of factors: relaxation of the lower esophageal sphincter, hypersecretion of gastric acid, and resulting burning of the esophageal mucosa. Symptoms are usually classified as classic, atypical, or complicated. Treatment approaches include dietary and lifestyle changes, reduction of acidity with use of H2

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receptor antagonists, and reduction of acid secretion with use of proton pump inhibitors. The author stresses that patient motivation is an important factor in the management of GERD. In rare instances, patients do not respond to medical treatment and are candidates for antireflux surgery. 1 figure. 1 table. 7 references. (AA-M). •

Heartburn: When to Worry Source: Patient Care. 35(8): 40-42, 46-49. April 30, 2001. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: With the exception of situational heartburn, which is defined as occurring no more than once a month, the substernal (behind or under the breastbone) burning sensation many patients experience is always more than a minor symptom. At best, it characterizes gastroesophageal reflux disease (GERD), a chronic condition; at worst, it signals a premalignant condition or potentially fatal coronary disease. This article focuses on the serious complications of GERD rather than occasional heartburn. While antacides and lifestyle modifications are recommended early stage interventions, they are no substitute for prescription medications and possibly surgery in the face of severe esophagitis or Barrett's esophagus (BE). The authors note that lifestyle modifications definitely have a role in GERD therapy. However, the available medications can heal esophageal damage, prevent further damage from occurring, and significantly relieve the troubling symptoms associated with GERD. When patients present with heartburn, specific questions about the sensation experienced, what precipitates it, and the duration of the symptoms help pinpoint the diagnosis. Persistent extraesophageal symptoms such as asthma, cough, and noncardiac chest pain may be signs of GERD. Alarm symptoms such as dysphagia, odynophagia, weight loss, gastrointestinal (BI) bleeding, and anemia require immediate endoscopy. Patients with BE should be monitoring in a surveillance program for detecting early signs of malignancy. One table summarizes recommended dosages, indications, and side effects of medications commonly used to treat GERD. 1 figure. 1 table. 15 references.

Federally Funded Research on Heartburn The U.S. Government supports a variety of research studies relating to heartburn. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to heartburn. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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animals or simulated models to explore heartburn. The following is typical of the type of information found when searching the CRISP database for heartburn: •

Project Title: ESOSPHAGUS

A

NOVEL

TECHNIQUE

FOR

SCREENING

BARRETT'S

Principal Investigator & Institution: Wang, Kenneth K.; Associate Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Gastroesophageal cancers are the most rapidly increasing cancer in Caucasian males and are a consequence of Barrett's esophagus. Barrett's esophagus is a pre-malignant condition that is produced by gastroesophageal reflux disease (heartburn). Screening for Barrett's esophagus can only be accomplished by endoscopy that is expensive and impractical given the population at risk. The purpose of this proposal is to design an "optical biopsy" system that can be applied by a wide range of health care providers to screen for Barrett's esophagus. This system will consist of an optical probe that can be placed into the esophagus with minimal discomfort to the patient that is connected to an optical biopsy console that will provide real time results. The primary design issues will be in constructing a small caliber probe that can be comfortably placed into the esophagus and yet expandable to provide contact with the esophageal wall for an optical biopsy. The second design consideration would be in constructing an algorithm that would analyze the spectroscopic signal from the "optical biopsy" which would distinguish normal and abnormal tissue in the upper gastrointestinal tract. Three proposed probe designs will be evaluated initially in the resected porcine esophagus and stomach to assess deployment of the probes and their safety. Subsequently, the probes will be assessed in the pig model to evaluate their performance characteristics. The best design will be selected for clinical testing. The clinical trials will involve the use of the probe in patients with known Barrett's esophagus and a control group undergoing endoscopy for other indications. The probe would be passed prior to endoscopy and the results compared to the endoscopic findings. The algorithms will be derived from optical and histological biopsies taken simultaneously at endoscopy from patients undergoing surveillance endoscopy for Barrett's esophagus. The development of a screening device for Barrett's esophagus that could be operated by paramedical personnel would enable large-scale low cost screening to identify patients at risk for esophageal cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ESOPHAGEAL CYTOPROTECTION--AGENTS AND MECHANISMS Principal Investigator & Institution: Orlando, Roy C.; Professor of Medicine & Chief; Medicine; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2001; Project Start 01-AUG-1986; Project End 31-AUG-2004 Summary: The long term goal of this proposal is to understand the pathogenesis of the human disease, reflux esophagitis (RE), and this approached mechanistically and from the relatively uncommon vantage point of the target tissue, the esophageal epithelium (EE). In this grant, we focus on the barrier properties of the EE, and especially that of the intercellular junctions (ICJs). The ICJs have importance as an essential defense against H+ entry into EE and as the initial target for H+ attack and damage that culminates in esophagitis. Therefore, one major goal is to characterize the barrier properties to select ions and molecules of the lumen-facing, apical cell membranes (ACMs) and ICJs using in vitro rabbit EE in Ussing chambers, and to determine how exposure to luminal acid

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alters these properties. Also, since many patients with RE have normal acid contact time on pH monitoring, experiments in Ussing chambered-EE are designed to identify (nonacidic) factors within the refluxate, meals and the esophageal inflammatory reaction that can contibute to breaking the barriers to H+ entry into EE, and for those identified, to localize the site of action to ACMs and/or ICJs and characterize, by pH-microelectrodes, the ability to lower pHi. Further, there is evidence to suggest that patients with RE have defects in (epithelial) barrier function, and that those with nonerosive esophagitis have damage localized to the ICJs. Since localization to the ICJs is key to validating our proposed pathogenesis of heartburn and esophagitis, another goal is to confirm, using in vivo PD measurements during salt superfasions, that this defect is localized to the ICJs. Moreover, there is a high rate of relapse following medical therapy and preliminary data suggest that this is attributable to persistent defects within the EE. Therefore, we hypothesize that the defects are due to persistent esophageal inflammation and studies proposed to correlate histologic esophagitis on endoscopic biopsy with relapse frequency after cessation of medical therapy. Also, defects in epithelial defense are sought by PD measurements during acid perfusion in asymptomatic elderly Caucasian males, a group at high risk for RE, and if found, to determine if the defect is in the barrier, and age or genetics related. Another goal is to use morphology (epifluorescence/confocal microscopy, freeze fracture, TEM, immunocytochemistry). Ussing chambers and SDS-PAGE technology, to study the structure/function of the ICJs in healthy EE and to assess the mechanisms of H+ damage. This effort coupled with the studies above should provide new insights into the pathogenesis of RE. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LASER CATHETER FOR TREATMENT OF GASTROESOPHAGEAL REFLUX Principal Investigator & Institution: Gowda, Ashok; Biotex, Inc. 8018 El Rio Houston, Tx 770544104 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 30-SEP-2002 Summary: ( Investigator's Abstract): Gastroesophageal reflux disease (GERD) is a physical condition resulting from an inability of the lower esophageal sphincter (LES) to prevent reflux of stomach acids into the esophagus. This disease along with its associated problems is presenting in increasing numbers across the general population and current non-surgical options, in addition to being expensive, treat only the symptoms as opposed to correction of the defect. Additionally, there is increasing evidence that GERD may lead to significant increases in the risk for cancer development. The focus of this research is to develop a novel enodscopic-based laser delivery system for treatment of GERD. In this phase I study the investigators propose to develop and test a laser delivery catheter able to create a single homogeneous thermal lesion along the length of the LES. Innovative features of the catheter allow it to thermally treat the muscular layer while preventing damage to the esophageal mucosa. Studies are planned to allow optimization of the catheter's delivery parameters in vitro followed by in vivo testing in a porcine model. The investigators plan to demonstrate feasibility by assessing the system in terms of its efficacy in augmenting barrier function by improving gastric yield pressure. PROPOSED COMMERCIAL APPLICATION: It is estimated that 33% of the adult population experience heartburn at least once a month and approximately 14 million Americans, or 7% of the adult population, suffer from gastroesophageal reflux disorder (GERD). The current annual worldwide market for drugs used to treat (GERD) is approximately $14 billion. Of the 14 million GERD suffers in the U.S., only 70,000

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elected for corrective invasive surgery. An effective non-surgical alternative would significantly increase the number of patients seeking permanent correction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICAL AND SURGICAL TREATMENT OF ESOPHAGEAL REFLUX Principal Investigator & Institution: Finlayson, Samuel R.; Surgery; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2004 Summary: Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. Approximately 75 million Americans suffer from "heartburn", the most typical symptom of GERD. Heartburn can severely impact quality of life and leads to an estimated 15 million physician consultations per year. Both medical and surgical treatments have been shown to be effective in controlling symptoms of GERD, but surgical intervention has traditionally been reserved for selected patients with intractable symptoms. However, for both medical and surgical treatment of GERD, the landscape has changed significantly in the last decade. Proton pump inhibitor therapy has proven vastly superior to older anti- acid medications. Concurrently, the advent of minimally invasive laparoscopic surgery as substantially lowered the threshold for surgical treatment of GERD and led to substantial increases in rates of anti-reflux surgery. Both of these advances have sharpened the debate surrounding optimal treatment of GERD, but at present there is insufficient evidence on which to base comparispon of medical and surgical treatment. A careful, prospective, multi-enter, randomized clinical trial would be the ideal mechanism for comparing proton pump inhibitor therapy and laparoscopic anti-reflux surgery for GERD. The purpose of this application is to seek funds to design and plan such a trial. As members of an experienced clinical trial consortium, we recognize that conducing this trial will require successfully overcoming several important challenges, including issues of patient recruitment and retention, generalizability, and measurement of quality-of-life outcomes. The R03 grant would provide the required financial resources to carefully address these challenges. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: STUDY OF THE INTERFACE BETWEEN ALUMINUM HYDROXIDE AND SELECTED MOLECULES OF LIFE Principal Investigator & Institution: Phambu, Nsoki; Johnson C Smith University Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: The long-term goal of our work is to propose a new type of well-defined aluminum hydroxide as a new candidate for a stronger and safer antacid. It will be used to reduce absorption of phosphorus for people with kidney failure, and in the treatment of heartburn, gastritis, and peptic ulcer. The mechanisms of interactions between these well-defined aluminum hydroxides and enzymes, proteins, antibiotics, living cells, and dietary supplements will be investigated in order to recommend this chemical as an antacid. The first hypothesis being evaluated is that this new aluminum hydroxide will release fewer aluminum species into the body; will have a higher acid-neutralizing capability, neutralization velocity, acid consuming capacity, and chemical activity; will have less sodium content compared to the antacids in current use. The second hypothesis is that aluminum compounds may act via direct cytoprotective action or by binding to pathogens. Dissolution testers will be used to evaluate in-vitro release of the

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drug from solid form as a function of time. Autotitrators will be used to calculate kinetic and conditional stability constants. The ability of infrared and Raman spectroscopies to determine structural and environmental information concerning biomolecules at low concentration in solution make them very powerful bioanalytical and biophysical techniques. In particular, the attenuated total reflection will be used for in-situ and invivo studies. For the first time, an atomic absorption spectrometer will be an indispensable tool in determining the amount of aluminum species released into the body for people taking aluminum-containing antacids. Textural and superficial characterization of the aluminum hydroxide powder will be done by adsorption isotherms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SYNAPTIC TRANSMISSION IN DIABETIC ENTERIC NERVOUS SYSTEM Principal Investigator & Institution: Lepard, Kathy J.; Physiology; Midwestern University 555 31St St Downers Grove, Il 60515 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: (Applicant's abstract): Gastrointestinal (GI) disturbances are not normally life-threatening but do profoundly affect quality of life. Diabetic patients often experience a wide range of GI discomforts including heartburn, nausea, vomiting, diarrhea, constipation, fecal incontinence and abdominal pain. Many patients have abnormalities in motility arising from identifiable conditions; but over 50% of GI complaints are idiopathic and are indicative of autonomic neuropathy. Both enteric nerves in and sympathetic nerves to the GI tract undergo neuropathy in animal models of diabetes as supported by immunohistochemical, histological, and functional data. A streptozotocin-induced diabetic guinea pig model will be used to isolate and evaluate alterations in sympathetic and enteric nerve activity at the histochemical, functional and cellular level. Neuropathy of enteric neurons will be investigated immunohistochemically by quantifying enzyme and peptide content of the small intestine, functionally by recording contractions/ relaxations from circular/ longitudinal smooth muscle strips of small intestine and cellularly by recording junction potentials from smooth muscle cells. Neuropathy of sympathetic neurons will be evaluated histochemically by quantifying norepinephrine (NE) content of small intestine and cellularly by recording NE mediated inhibitory postsynaptic potentials from submucosal neurons and by evaluating presynaptic inhibition of enteric neurotransmission by NE. Experimental data will be correlated with metabolic indices (body weight, glycosylated hemoglobin and plasma glucose) to determine normal control deviations and degree of diabetic severity with the intent of identifying a threshold for GI dysfunction. By defining the individual contribution of sympathetic and enteric neuropathies to dysfunctional GI motility, targets for therapeutic intervention to improve patient quality of life will be pinpointed. Adaptations of enteric neurons to diabetes will provide insight into enteric plasticity occurring in other GI diseases such as neuronal intestinal dysplasia, achalasia, scleroderma, pyloric stenosis, idiopathic constipation, diverticular disease, Parkinson's disease, and paraneoplastic syndromes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE PREVALENCE OF BARRETT'S ESOPHAGUS IN PATIENTS WITH * Principal Investigator & Institution: Jobe, Blair A.; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): The incidence of esophageal adenocarcinoma arising from Barrett's metaplasia has increased by 350% since 1970 and at the time of presentation, 50% of patients will have advanced disease with virtually no chance for cure. The prognosis for esophageal adenocarcinoma arising from Barrett's metaplasia is poor: The overall 5-year survival rate is less than 10%. Patients with classic and chronic symptoms of gastroesophageal reflux disease (GERD) undergo endoscopic screening for Barrett's metaplasia. Several retrospective studies have demonstrated an earlier stage of diagnosis and a marked improvement in survival of patients with cancers detected by routine endoscopic surveillance for Barrett's esophagus. In spite of these efforts, the majority of patients who develop esophageal adenocarcinoma are unaware of the presence of Barrett's metaplasia prior to cancer diagnosis. In addition, a large proportion of these patients have never reported symptoms of GERD. These findings suggest that the majority of patients who are at highest risk for the development of esophageal adenocarcinoma are never screened for Barrett's metaplasia. Some investigators have suggested that patients who develop esophageal cancer may not have typical GERD symptoms and therefore are not identified for endoscopic screening. As a result, occult disease progression occurs and advanced cancer is present at the time of diagnosis. Substantial published data support a causal relation between complicated GERD (esophagitis and Barrett's metaplasia) and extraesophageal reflux symptoms. The prevalence of GERD-related esophageal injury in patients with isolated extraesophageal symptoms (i.e., no heartburn or regurgitation) is unknown. The primary aim of this study is to establish that patients with symptoms of extraesophageal reflux who are referred to an otolaryngology clinic have a prevalence of Barrett's metaplasia equivalent to that of a population with GERD symptoms. We will compare the prevalence of biopsy proven Barrett's metaplasia in patients with extraesophageal reflux symptoms with patients who have GERD symptoms and those who do not have GERD symptoms. The two comparison groups will be prospectively accrued through the Clinical Outcomes Research Initiative (CORI) endoscopic database at Oregon Health and Science University and the Portland VA Medical Center. This pilot study will provide needed data to improve risk stratification for esophageal adenocarcinoma and potentially modify the inclusion criteria for routine Barrett's screening. In addition, this study will enhance our understanding of the natural history of esophageal injury in patients with extraesophageal reflux and raise awareness of non-GERD risk factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National

3

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

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Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “heartburn” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for heartburn in the PubMed Central database: •

Heartburn treatment in primary care: randomised, double blind study for 8 weeks. by Hatlebakk JG, Hyggen A, Madsen PH, Walle PO, Schulz T, Mowinckel P, Bernklev T, Berstad A.; 1999 Aug 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28208

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with heartburn, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “heartburn” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for heartburn (hyperlinks lead to article summaries): •

A double-blind, placebo-controlled study of the effectiveness and safety of nizatidine in the prevention of postprandial heartburn. Author(s): Spiegel JE, Thoden WR, Pappas K, Fratarcangelo P, Furey SA. Source: Archives of Internal Medicine. 1997 July 28; 157(14): 1594-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9236562&dopt=Abstract

•

A double-blind, placebo-controlled study of the efficacy and safety of nonprescription ranitidine 75 mg in the prevention of meal-induced heartburn. Author(s): Pappa KA, Williams BO, Payne JE, Buaron KS, Mussari KL, Ciociola AA. Source: Alimentary Pharmacology & Therapeutics. 1999 April; 13(4): 467-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215730&dopt=Abstract

4

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A lot of heartburn, a little cancer. Author(s): Ormseth EJ, Wong RK. Source: The American Journal of Gastroenterology. 1999 October; 94(10): 3061-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10520872&dopt=Abstract

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A practical approach to heartburn. Author(s): Castell DO. Source: Hosp Pract (Off Ed). 1999 November 15; 34(12): 89-94, 97-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10616547&dopt=Abstract

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A randomized, double-blind comparison of two different coffee-roasting processes on development of heartburn and dyspepsia in coffee-sensitive individuals. Author(s): DiBaise JK. Source: Digestive Diseases and Sciences. 2003 April; 48(4): 652-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741451&dopt=Abstract

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A study of the nonprescription drug consumer's understanding of the ranitidine product label and actual product usage patterns in the treatment of episodic heartburn. Author(s): Ciociola AA, Sirgo MA, Pappa KA, McGuire JA, Fung K. Source: American Journal of Therapeutics. 2001 November-December; 8(6): 387-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704777&dopt=Abstract

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ABC of the upper gastrointestinal tract: Oesophagus: heartburn. Author(s): de Caestecker J. Source: Bmj (Clinical Research Ed.). 2001 September 29; 323(7315): 736-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576983&dopt=Abstract

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Abnormal lower esophageal sphincter pressure responses in patients with orange juice-induced heartburn. Author(s): Cranley JP, Achkar E, Fleshler B. Source: The American Journal of Gastroenterology. 1986 February; 81(2): 104-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3946363&dopt=Abstract

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An evaluation of increasing doses of ranitidine for treatment of heartburn. Author(s): Pappa KA, Buaron K, Payne JE, Sirgo MA, Giefer EE. Source: Alimentary Pharmacology & Therapeutics. 1999 April; 13(4): 475-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215731&dopt=Abstract

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An open-label, multicentre study to assess the safety and efficacy of a novel reflux suppressant (Gaviscon Advance) in the treatment of heartburn during pregnancy. Author(s): Lindow SW, Regnell P, Sykes J, Little S. Source: Int J Clin Pract. 2003 April; 57(3): 175-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723718&dopt=Abstract

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Antacids vs. antacids plus non-prescription ranitidine for heartburn during pregnancy. Author(s): Rayburn W, Liles E, Christensen H, Robinson M. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1999 July; 66(1): 35-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10458549&dopt=Abstract

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Are esophageal symptoms reflux-related? A study of different scoring systems in a cohort of patients with heartburn. Author(s): Johnston BT, Collins JS, McFarland RJ, Love AH. Source: The American Journal of Gastroenterology. 1994 April; 89(4): 497-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8147349&dopt=Abstract

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Assessment of relationship between acid reflux and heartburn using receiver operating characteristic curves. Author(s): Steinbach J, Fass R, Mittal RK. Source: Gastroenterology Clinics of North America. 2002 December; 31(4 Suppl): S45-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12489470&dopt=Abstract

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Beyond heartburn: extraesophageal manifestations of gastroesophageal reflux disease. Author(s): Richter JE. Source: Am J Manag Care. 2001 February; 7(1 Suppl): S6-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11225351&dopt=Abstract

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By the way, doctor. I take 10 mg of Prilosec about four times each week to control my heartburn. Does taking this drug on a continuing basis affect my body's ability to utilize nutrients in food? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 1999 November; 7(3): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10521942&dopt=Abstract

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By the way, doctor.I am 72 years old and generally healthy, but I have an annoying problem: at the end of the day, my voice gets weak and hoarse. I wonder if it's related to my heartburn, which wakes me up occasionally with an acid taste in my throat and mouth. I drink a lot of coffee, and I used to be a heavy smoker but gave that up 15 years ago. Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 June; 25(8): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10810068&dopt=Abstract

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Chocolate and heartburn: evidence of increased esophageal acid exposure after chocolate ingestion. Author(s): Murphy DW, Castell DO. Source: The American Journal of Gastroenterology. 1988 June; 83(6): 633-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3376917&dopt=Abstract

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Chronic heartburn: who can we safely NOT scope? Author(s): DeVault KR. Source: Journal of Clinical Gastroenterology. 2001 October; 33(4): 260-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588537&dopt=Abstract

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Cimetidine QID and BID in rapid heartburn relief and healing of lesions in gastroesophageal reflux disease. Author(s): Palmer RH, Miller DM, Hedrich DA, Karlstadt RG. Source: Clinical Therapeutics. 1993 November-December; 15(6): 994-1001. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8111819&dopt=Abstract

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Cisapride 20 mg b.i.d. provides symptomatic relief of heartburn and related symptoms of chronic mild to moderate gastroesophageal reflux disease. CIS-USA-52 Investigator Group. Author(s): Castell DO, Sigmund C Jr, Patterson D, Lambert R, Hasner D, Clyde C, Zeldis JB. Source: The American Journal of Gastroenterology. 1998 April; 93(4): 547-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9576446&dopt=Abstract

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Clinical effectiveness of a new antacid chewing gum on heartburn and oesophageal pH control. Author(s): Collings KL, Rodriguez-Stanley S, Proskin HM, Robinson M, Miner PB Jr. Source: Alimentary Pharmacology & Therapeutics. 2002 December; 16(12): 2029-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452946&dopt=Abstract

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Comparing lansoprazole and omeprazole in onset of heartburn relief: results of a randomized, controlled trial in erosive esophagitis patients. Author(s): Richter JE, Kahrilas PJ, Sontag SJ, Kovacs TO, Huang B, Pencyla JL. Source: The American Journal of Gastroenterology. 2001 November; 96(11): 3089-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11721754&dopt=Abstract

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Complete resolution of heartburn symptoms and health-related quality of life in patients with gastro-oesophageal reflux disease. Author(s): Revicki DA, Crawley JA, Zodet MW, Levine DS, Joelsson BO. Source: Alimentary Pharmacology & Therapeutics. 1999 December; 13(12): 1621-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10594397&dopt=Abstract

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Counseling the patient with heartburn. Author(s): Horn JR. Source: Am Pharm. 1991 March; Ns31(3): 86-91. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2028914&dopt=Abstract

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Determinants of pregnancy heartburn. Author(s): Marrero JM, Goggin PM, de Caestecker JS, Pearce JM, Maxwell JD. Source: British Journal of Obstetrics and Gynaecology. 1992 September; 99(9): 731-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1420011&dopt=Abstract

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Duodenal fat intensifies the perception of heartburn. Author(s): Meyer JH, Lembo A, Elashoff JD, Fass R, Mayer EA. Source: Gut. 2001 November; 49(5): 624-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11600463&dopt=Abstract

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Dyspepsia and heartburn. Author(s): Ahmad NA, Metz DC. Source: Rheumatic Diseases Clinics of North America. 1999 August; 25(3): 703-18, X. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10467636&dopt=Abstract

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Economic heartburn: average cost-effectiveness and gastroesophageal reflux disease. Author(s): Harris RA, Nease RF. Source: Gastroenterology. 1995 January; 108(1): 303-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7806058&dopt=Abstract

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Effectiveness and safety of nizatidine, 75 mg, for the relief of episodic heartburn. Author(s): Paul K, Redman CM, Chen M. Source: Alimentary Pharmacology & Therapeutics. 2001 October; 15(10): 1571-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11563996&dopt=Abstract

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Effectiveness of foaming antacid in relieving induced heartburn. Author(s): Lanza FL, Smith V, Page-Castell JA, Castell DO. Source: Southern Medical Journal. 1986 March; 79(3): 327-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3513329&dopt=Abstract

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Effects of antacid formulation on postprandial oesophageal acidity in patients with a history of episodic heartburn. Author(s): Robinson M, Rodriguez-Stanley S, Miner PB, McGuire AJ, Fung K, Ciociola AA. Source: Alimentary Pharmacology & Therapeutics. 2002 March; 16(3): 435-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11876696&dopt=Abstract

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Endoscopist's nirvana or new heartburn for third-party payers? Author(s): Cheskin LJ, Schuster MM. Source: The American Journal of Gastroenterology. 1991 May; 86(5): 644-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2028962&dopt=Abstract

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Esophageal acid contact time and heartburn in acute treatment with ranitidine and metoclopramide. Author(s): Orr WC, Finn A, Wilson T, Russell J. Source: The American Journal of Gastroenterology. 1990 June; 85(6): 697-700. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2191595&dopt=Abstract

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Esophageal hypersensitivity may be a major cause of heartburn. Author(s): Rodriguez-Stanley S, Robinson M, Earnest DL, Greenwood-Van Meerveld B, Miner PB Jr. Source: The American Journal of Gastroenterology. 1999 March; 94(3): 628-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10086642&dopt=Abstract

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Esophageal motility, heartburn, and gastroesophageal reflux: variations in clinical presentation of esophageal dysphagia. Author(s): Decktor DL, Allen ML, Robinson M. Source: Dysphagia. 1990; 5(4): 211-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2272220&dopt=Abstract

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Excess adipose and heartburn. Author(s): Clements WD, Rice P, Harvey C. Source: Postgraduate Medical Journal. 1997 June; 73(860): 369-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9246347&dopt=Abstract

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Factor structure of the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire evaluated in patients with heartburn predominant reflux disease. Author(s): Kulich KR, Wiklund I, Junghard O. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2003 September; 12(6): 699-708. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516179&dopt=Abstract

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FDA warns about heartburn drug. Author(s): Josefson D. Source: Bmj (Clinical Research Ed.). 1998 July 11; 317(7151): 101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9696609&dopt=Abstract

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First the chicken, then the egg; the heartburn came later. Author(s): Williams A. Source: Medicine and Health, Rhode Island. 1997 May; 80(5): 163-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9150682&dopt=Abstract

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Functional heartburn: the stimulus, the pain, and the brain. Author(s): Fass R, Tougas G. Source: Gut. 2002 December; 51(6): 885-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427796&dopt=Abstract

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Gastroesophageal reflux and transit scintigraphy: a comparison with esophageal biopsy in patients with heartburn. Author(s): Styles CB, Holt S, Bowes KL, Jewell L, Hooper HR. Source: J Can Assoc Radiol. 1984 June; 35(2): 124-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6480663&dopt=Abstract

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Gastroesophageal reflux disease: gaining control over heartburn. Author(s): Larsen RR. Source: Postgraduate Medicine. 1997 February; 101(2): 181-2, 185-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9046934&dopt=Abstract

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Gastroesophageal reflux. Don't forget to ask about heartburn. Author(s): Castell DO, Holtz A. Source: Postgraduate Medicine. 1989 October; 86(5): 141-4, 147-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2678058&dopt=Abstract

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Health care seeking by heartburn sufferers is associated with psychosocial factors. Author(s): Johnston BT, Gunning J, Lewis SA. Source: The American Journal of Gastroenterology. 1996 December; 91(12): 2500-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8946974&dopt=Abstract

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Heartburn and gastro-oesophageal reflux. Author(s): Bennett JR. Source: Br J Clin Pract. 1991 Winter; 45(4): 273-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1810362&dopt=Abstract

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Heartburn and reflux oesophagitis. Author(s): Duggan JM, Duggan A. Source: Journal of Gastroenterology and Hepatology. 2000 January; 15(1): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10719739&dopt=Abstract

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Heartburn correlated to 24-hour pH monitoring and radiographic examination of the esophagus. Author(s): Ott DJ, McManus CM, Ledbetter MS, Chen MY, Gelfand DW. Source: The American Journal of Gastroenterology. 1997 October; 92(10): 1827-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9382045&dopt=Abstract

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Heartburn for the patient--heartache for the doctor? Author(s): Gibson MA, Varghese A, Clarke KE, Irwin WG, Love AG. Source: British Medical Journal (Clinical Research Ed.). 1983 August 13; 287(6390): 465-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6411177&dopt=Abstract

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Heartburn in Belgium: prevalence, impact on daily life, and utilization of medical resources. Author(s): Louis E, DeLooze D, Deprez P, Hiele M, Urbain D, Pelckmans P, Deviere J, Deltenre M. Source: European Journal of Gastroenterology & Hepatology. 2002 March; 14(3): 279-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11953693&dopt=Abstract

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Heartburn in patients with achalasia. Author(s): Robertson GS, Veitch PS, Wicks AC. Source: Gut. 1996 March; 38(3): 475. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8675109&dopt=Abstract

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Heartburn in patients with achalasia. Author(s): Spechler SJ, Souza RF, Rosenberg SJ, Ruben RA, Goyal RK. Source: Gut. 1995 September; 37(3): 305-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7590421&dopt=Abstract

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Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication. Author(s): Farrell TM, Archer SB, Galloway KD, Branum GD, Smith CD, Hunter JG. Source: The American Surgeon. 2000 March; 66(3): 229-36; Discussion 236-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10759191&dopt=Abstract

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Heartburn redux. Author(s): Cascade PN. Source: Ajr. American Journal of Roentgenology. 1998 October; 171(4): 1162. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9763020&dopt=Abstract

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Heartburn requiring frequent antacid use may indicate significant illness. Author(s): Robinson M, Earnest D, Rodriguez-Stanley S, Greenwood-Van Meerveld B, Jaffe P, Silver MT, Kleoudis CS, Wilson LE, Murdock RH. Source: Archives of Internal Medicine. 1998 November 23; 158(21): 2373-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9827789&dopt=Abstract

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Heartburn risk factors, knowledge, and prevention strategies: a population-based survey of individuals with heartburn. Author(s): Oliveria SA, Christos PJ, Talley NJ, Dannenberg AJ. Source: Archives of Internal Medicine. 1999 July 26; 159(14): 1592-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10421282&dopt=Abstract

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Heartburn severity can predict pathologic oesophageal reflux in gastro-oesophageal reflux disease patients treated with a proton-pump inhibitor. Author(s): Gardner JD, Sloan S, Robinson M, Miner PB Jr. Source: Alimentary Pharmacology & Therapeutics. 2003 July 1; 18(1): 133-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848635&dopt=Abstract

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Heartburn treated with tapwater. Author(s): Engel D. Source: Medical Hypotheses. 1983 April; 10(4): 407-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6877118&dopt=Abstract

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Heartburn treatment in primary care. Prescribing omeprazole would conflict with desire to control prescribing costs. Author(s): Williams A. Source: Bmj (Clinical Research Ed.). 2000 May 20; 320(7246): 1406-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858061&dopt=Abstract

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Heartburn treatment in primary care. Step up approach to management is best. Author(s): Saxena S, Pollok RC. Source: Bmj (Clinical Research Ed.). 2000 May 20; 320(7246): 1407. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858062&dopt=Abstract

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Heartburn treatment in primary care. Study's results seem to be promotional rather than evidence based. Author(s): Alberti H. Source: Bmj (Clinical Research Ed.). 2000 May 20; 320(7246): 1407. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858063&dopt=Abstract

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Heartburn treatment in primary care: randomised, double blind study for 8 weeks. Author(s): Hatlebakk JG, Hyggen A, Madsen PH, Walle PO, Schulz T, Mowinckel P, Bernklev T, Berstad A. Source: Bmj (Clinical Research Ed.). 1999 August 28; 319(7209): 550-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10463897&dopt=Abstract

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Heartburn ulcers. Author(s): Press HC Jr, Cantwell KG. Source: Journal of the National Medical Association. 1987 December; 79(12): 1263-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3430645&dopt=Abstract

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Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response. Author(s): Lind T, Havelund T, Carlsson R, Anker-Hansen O, Glise H, Hernqvist H, Junghard O, Lauritsen K, Lundell L, Pedersen SA, Stubberod A. Source: Scandinavian Journal of Gastroenterology. 1997 October; 32(10): 974-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9361168&dopt=Abstract

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Heartburn, oesophagitis and Barrett's oesophagus in self-medicating patients in general practice. Author(s): Corder AP, Jones RH, Sadler GH, Daniels P, Johnson CD. Source: Br J Clin Pract. 1996 July-August; 50(5): 245-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8794600&dopt=Abstract

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Heartburn. Author(s): Murtagh J. Source: Aust Fam Physician. 1992 April; 21(4): 520. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1530481&dopt=Abstract

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Heartburn: community perceptions. Author(s): Bolin TD, Korman MG, Hansky J, Stanton R. Source: Journal of Gastroenterology and Hepatology. 2000 January; 15(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10719745&dopt=Abstract

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Heartburn: could the heart be really burning? Author(s): Sivaram CA, Minocha A. Source: The American Journal of Gastroenterology. 1997 January; 92(1): 178-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8995972&dopt=Abstract

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Heartburn: let's help patients take it seriously. Author(s): Weart CW. Source: Journal of the American Pharmaceutical Association (Washington,D.C. : 1996). 2001 May-June; 41(3): 469-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372915&dopt=Abstract

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Heartburn--a serious symptom. Author(s): Cohen S, Parkman HP. Source: The New England Journal of Medicine. 1999 March 18; 340(11): 878-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10080852&dopt=Abstract

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Heartburn--lifting the veil of mythology. Author(s): Breen KJ. Source: The Medical Journal of Australia. 1993 January 4; 158(1): 67-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8417303&dopt=Abstract

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Heartburn--lifting the veil of mythology. Author(s): Dent J. Source: The Medical Journal of Australia. 1992 September 21; 157(6): 366-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1360141&dopt=Abstract

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Heartburn--the acid test. Author(s): Joelsson B, Johnsson F. Source: Gut. 1989 November; 30(11): 1523-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2599437&dopt=Abstract

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High- versus standard-dose ranitidine for control of heartburn in poorly responsive acid reflux disease: a prospective, controlled trial. Author(s): Kahrilas PJ, Fennerty MB, Joelsson B. Source: The American Journal of Gastroenterology. 1999 January; 94(1): 92-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9934737&dopt=Abstract

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How do some spell relief? S-u-r-g-e-r-y. Permanent relief for heartburn sufferers. Author(s): Evangelisto M. Source: Today's Surgical Nurse. 1997 January-February; 19(1): 22-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9233300&dopt=Abstract

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Impact of Helicobacter pylori eradication on heartburn in patients with gastric or duodenal ulcer disease -- results from a randomized trial programme. Author(s): Malfertheiner P, Dent J, Zeijlon L, Sipponen P, Veldhuyzen Van Zanten SJ, Burman CF, Lind T, Wrangstadh M, BayerdOrffer E, Lonovics J. Source: Alimentary Pharmacology & Therapeutics. 2002 August; 16(8): 1431-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12182742&dopt=Abstract

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Indigestion and heartburn: a descriptive study of prevalence in persons seeking care from chiropractors. Author(s): Bryner P, Staerker PG. Source: Journal of Manipulative and Physiological Therapeutics. 1996 June; 19(5): 317-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8792321&dopt=Abstract

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Is amiodarone good for heartburn? Author(s): Martin D, Lown B. Source: Archives of Internal Medicine. 1990 June; 150(6): 1345-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2353867&dopt=Abstract

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Is mucaine an appropriate medication for the relief of heartburn during pregnancy? Author(s): Kovacs GT, Campbell J, Francis D, Hill D, Adena MA. Source: Asia Oceania J Obstet Gynaecol. 1990 December; 16(4): 357-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2099731&dopt=Abstract

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Is there a difference between GERD and chronic heartburn? How should they be treated? Author(s): Bickston SJ. Source: Health News. 2000 May; 6(5): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10851977&dopt=Abstract

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I've heard that chronic heartburn can lead to esophageal cancer. How commonly does heartburn progress to cancer, and can it be prevented? Author(s): Johnson D. Source: Health News. 2002 May; 8(5): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132405&dopt=Abstract

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I've heard that people with heartburn are at increased risk for developing cancer of the esophagus. Is this true? Author(s): Goldfinger SE. Source: Harvard Health Letter / from Harvard Medical School. 1998 November; 24(1): 3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9857848&dopt=Abstract

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Just a little heartburn? Author(s): Green JA, Amaro R, Barkin JS. Source: The American Journal of Gastroenterology. 2000 March; 95(3): 813-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10710084&dopt=Abstract

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Lansoprazole in the treatment of heartburn in patients without erosive oesophagitis. Author(s): Richter JE, Kovacs TO, Greski-Rose PA, Huang section sign B, Fisher R. Source: Alimentary Pharmacology & Therapeutics. 1999 June; 13(6): 795-804. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10383510&dopt=Abstract

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Low dose famotidine in the prevention of sleep disturbance caused by heartburn after an evening meal. Author(s): Mann SG, Murakami A, McCarroll K, Rao AN, Cottrell J, Mehentee J, Morton R. Source: Alimentary Pharmacology & Therapeutics. 1995 August; 9(4): 395-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8527615&dopt=Abstract

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Low-dose lansoprazole provides greater relief of heartburn and epigastric pain than low-dose omeprazole in patients with acid-related dyspepsia. Author(s): Jones R, Crouch SL. Source: Alimentary Pharmacology & Therapeutics. 1999 March; 13(3): 413-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10102976&dopt=Abstract

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Low-dose ranitidine for the relief of heartburn. Author(s): Pappa KA, Gooch WM, Buaron K, Payne JE, Giefer EE, Sirgo MA, Ciociola AA. Source: Alimentary Pharmacology & Therapeutics. 1999 April; 13(4): 459-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215729&dopt=Abstract

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Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies. Author(s): Howden CW, Henning JM, Huang B, Lukasik N, Freston JW. Source: The American Journal of Gastroenterology. 2001 June; 96(6): 1704-10. Erratum In: Am J Gastroenterol 2001 September; 96(9): 2809. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11419818&dopt=Abstract

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Managing heartburn at the 'base' of the GERD 'iceberg': effervescent ranitidine 150 mg b.d. provides faster and better heartburn relief than antacids. Author(s): Earnest D, Robinson M, Rodriguez-Stanley S, Ciociola AA, Jaffe P, Silver MT, Kleoudis CS, Murdock RH. Source: Alimentary Pharmacology & Therapeutics. 2000 July; 14(7): 911-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10886047&dopt=Abstract

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Meal type affects heartburn severity. Author(s): Rodriguez S, Miner P, Robinson M, Greenwood B, Maton PN, Pappa K. Source: Digestive Diseases and Sciences. 1998 March; 43(3): 485-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9539641&dopt=Abstract

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Mechanisms of gastroesophageal acid reflux and esophageal acid clearance in heartburn patients. Author(s): Allen ML, Castell JA, DiMarino AJ Jr. Source: The American Journal of Gastroenterology. 1996 September; 91(9): 1739-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8792691&dopt=Abstract

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NICE issues guidance for heartburn and indigestion. Author(s): Ferriman A. Source: Bmj (Clinical Research Ed.). 2000 July 22; 321(7255): 197. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10903645&dopt=Abstract

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Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association. Author(s): Shaker R, Castell DO, Schoenfeld PS, Spechler SJ. Source: The American Journal of Gastroenterology. 2003 July; 98(7): 1487-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873567&dopt=Abstract

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Nonprescription doses of ranitidine are effective in the relief of episodic heartburn. Author(s): Ciociola AA, Pappa KA, Sirgo MA. Source: American Journal of Therapeutics. 2001 November-December; 8(6): 399-408. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704778&dopt=Abstract

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Oesophageal motility during acid-provoked heartburn and chest pain. Author(s): Kjellen G, Tibbling L. Source: Scandinavian Journal of Gastroenterology. 1985 October; 20(8): 937-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4081632&dopt=Abstract

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Omeprazole is more effective than cimetidine for the relief of all grades of gastrooesophageal reflux disease-associated heartburn, irrespective of the presence or absence of endoscopic oesophagitis. Author(s): Bate CM, Green JR, Axon AT, Murray FE, Tildesley G, Emmas CE, Taylor MD. Source: Alimentary Pharmacology & Therapeutics. 1997 August; 11(4): 755-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9305486&dopt=Abstract

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Omeprazole is more effective than cimetidine in the prevention of recurrence of GERD-associated heartburn and the occurrence of underlying oesophagitis. Author(s): Bate CM, Green JR, Axon AT, Tildesley G, Murrays FE, Owen SM, Emmas C, Taylor MD. Source: Alimentary Pharmacology & Therapeutics. 1998 January; 12(1): 41-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9692699&dopt=Abstract

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On demand therapy with omeprazole for the long-term management of patients with heartburn without oesophagitis--a placebo-controlled randomized trial. Author(s): Lind T, Havelund T, Lundell L, Glise H, Lauritsen K, Pedersen SA, AnkerHansen O, Stubberod A, Eriksson G, Carlsson R, Junghard O. Source: Alimentary Pharmacology & Therapeutics. 1999 July; 13(7): 907-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10383525&dopt=Abstract

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Onset of action during on-demand treatment with maalox suspension or low-dose ranitidine for heartburn. Author(s): Faaij RA, Van Gerven JM, Jolivet-Landreau I, Masclee AA, Vendrig EM, Schoemaker RC, Jacobs LD, Cohen AF. Source: Alimentary Pharmacology & Therapeutics. 1999 December; 13(12): 1605-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10594395&dopt=Abstract

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Pantoprazole rapidly improves health-related quality of life in patients with heartburn: a prospective, randomized, double blind comparative study with nizatidine. Author(s): Pare P, Armstrong D, Pericak D, Pyzyk M. Source: Journal of Clinical Gastroenterology. 2003 August; 37(2): 132-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869883&dopt=Abstract

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Patient response to marketing minimally invasive surgery for heartburn. Author(s): de Vos Shoop M, Peters JH, DeMeester TR, Crookes PF, Kline MM. Source: Surgical Endoscopy. 1998 March; 12(3): 261-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9502708&dopt=Abstract

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Patterns of consultation and treatment for heartburn: findings from a Singaporean community survey. Author(s): Ho KY, Kang JY, Seow A. Source: Alimentary Pharmacology & Therapeutics. 1999 August; 13(8): 1029-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10468677&dopt=Abstract

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Practical pointers for grappling with GERD. Heartburn gnaws at quality of life for many patients. Author(s): Szarka LA, Locke GR. Source: Postgraduate Medicine. 1999 June; 105(7): 88-90, 95-8, 103-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10376053&dopt=Abstract

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Prevalence of dyspepsia, heartburn, and peptic ulcer disease in veterans. Author(s): Dominitz JA, Provenzale D. Source: The American Journal of Gastroenterology. 1999 August; 94(8): 2086-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10445532&dopt=Abstract

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Prevention of heartburn relapse by low-dose famotidine: a test meal model for duration of symptom control. Author(s): Mann SG, Cottrell J, Murakami A, Stauffer L, Rao AN. Source: Alimentary Pharmacology & Therapeutics. 1997 February; 11(1): 121-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9042984&dopt=Abstract

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Quality of life in patients with endoscopy-negative heartburn: reliability and sensitivity of disease-specific instruments. Author(s): Talley NJ, Fullerton S, Junghard O, Wiklund I. Source: The American Journal of Gastroenterology. 2001 July; 96(7): 1998-2004. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11467624&dopt=Abstract

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Quality of life in patients with heartburn but without esophagitis: effects of treatment with omeprazole. Author(s): Havelund T, Lind T, Wiklund I, Glise H, Hernqvist H, Lauritsen K, Lundell L, Pedersen SA, Carlsson R, Junghard O, Stubberod A, Anker-Hansen O. Source: The American Journal of Gastroenterology. 1999 July; 94(7): 1782-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10406235&dopt=Abstract

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Randomised controlled trial of pantoprazole versus ranitidine for the treatment of uninvestigated heartburn in primary care. Author(s): Talley NJ, Moore MG, Sprogis A, Katelaris P. Source: The Medical Journal of Australia. 2002 October 21; 177(8): 423-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381251&dopt=Abstract

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Re: Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication. Author(s): Voeller GR. Source: The American Surgeon. 2001 February; 67(2): 199. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11243551&dopt=Abstract

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Re: Howden et al--Management of heartburn. Author(s): Bank S. Source: The American Journal of Gastroenterology. 2001 December; 96(12): 3469-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774992&dopt=Abstract

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Refractory heartburn. Author(s): Kahrilas PJ. Source: Gastroenterology. 2003 June; 124(7): 1941-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806626&dopt=Abstract

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Relationship of heartburn with histopathological changes in esophagus and stomach in patients with duodenal ulcer. Author(s): Lahoti D, Misra SP, Malhotra V, Vij JC. Source: Indian J Gastroenterol. 1991 April; 10(2): 54-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2040514&dopt=Abstract

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Relationships between the acidity and osmolality of popular beverages and reported postprandial heartburn. Author(s): Feldman M, Barnett C. Source: Gastroenterology. 1995 January; 108(1): 125-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7806034&dopt=Abstract

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Remedies for common family ailments: 1. Indigestion and heartburn. Author(s): Sinclair A. Source: Prof Care Mother Child. 1994 January-February; 4(1): 23-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8680151&dopt=Abstract

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Response of heartburn symptoms to a new cimetidine/alginate combination compared with an alginic acid/antacid. Author(s): Lennox B, Snell C, Lamb Y. Source: Br J Clin Pract. 1988 December; 42(12): 503-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3076786&dopt=Abstract

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Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Author(s): Mandel KG, Daggy BP, Brodie DA, Jacoby HI. Source: Alimentary Pharmacology & Therapeutics. 2000 June; 14(6): 669-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10848650&dopt=Abstract

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Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy. Author(s): Shay SS, Johnson LF, Wong RK, Curtis DJ, Rosenthal R, Lamott JR, Owensby LC. Source: Journal of Clinical Gastroenterology. 1986 April; 8(2): 115-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3462241&dopt=Abstract

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Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs. Author(s): Inadomi JM, McIntyre L, Bernard L, Fendrick AM. Source: The American Journal of Gastroenterology. 2003 September; 98(9): 1940-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499769&dopt=Abstract

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Structural analysis in medicine--hiatal hernia, heartburn, Hercules, and the Hydra. Author(s): Miller TQ, Sontag SJ. Source: Journal of Clinical Gastroenterology. 1991 December; 13(6): 617-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1761833&dopt=Abstract

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Studies on the relationship between esophageal acid exposure, mucosal lesions and heartburn using an acid exposure sensor. Author(s): Vantrappen G, Tack J, Huyberechts G, Sifrim D, Geboes K, Janmsens J, Van Overstraeten R. Source: Scandinavian Journal of Gastroenterology. 2002 November; 37(11): 1253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12465721&dopt=Abstract

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Sustained esophageal contraction: a motor correlate of heartburn symptom. Author(s): Pehlivanov N, Liu J, Mittal RK. Source: American Journal of Physiology. Gastrointestinal and Liver Physiology. 2001 September; 281(3): G743-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518687&dopt=Abstract

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Synergy between low-dose ranitidine and antacid in decreasing gastric and oesophageal acidity and relieving meal-induced heartburn. Author(s): Robinson M, Rodriguez-Stanley S, Ciociola AA, Filinto J, Zubaidi S, Miner PB Jr, Gardner JD. Source: Alimentary Pharmacology & Therapeutics. 2001 September; 15(9): 1365-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11552907&dopt=Abstract

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The hidden challenge of dyspepsia and heartburn: Is the world united? Summary and closing comments: key agenda for the coming years. Author(s): Tytgat G, Castell D. Source: European Journal of Gastroenterology & Hepatology. 1999 June; 11 Suppl 1: S43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10443912&dopt=Abstract

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The screening sensitivity of endoscopy, acid perfusion test and 24-hour pHmonitoring to evaluate esophagitis in patients with heartburn and histological esophagitis. Author(s): Navarro-Rodriguez T, de Moraes-Filho JP, Arakaki E, Chinzon D, Zaterka S, Iriya K, Laudanna AA. Source: Arquivos De Gastroenterologia. 1997 July-September; 34(3): 148-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9611292&dopt=Abstract

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The significance of heartburn. Author(s): Johnston BT. Source: Qjm : Monthly Journal of the Association of Physicians. 2000 June; 93(6): 321-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10873180&dopt=Abstract

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The symptom index. Differential usefulness in suspected acid-related complaints of heartburn and chest pain. Author(s): Singh S, Richter JE, Bradley LA, Haile JM. Source: Digestive Diseases and Sciences. 1993 August; 38(8): 1402-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8344094&dopt=Abstract

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Treatment of pyrosis does not insure adequate control of gastric acid reflux. Author(s): Collen MJ, Strong RM. Source: The American Journal of Gastroenterology. 1995 April; 90(4): 672-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7717342&dopt=Abstract

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True heartburn: a case of gastropericardial fistula. Author(s): Kaur H, Singh D, Kirschner ES, Maxwell JS. Source: Journal of Clinical Gastroenterology. 2001 May-June; 32(5): 458. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11319328&dopt=Abstract

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Use of H2-receptor antagonists in patients with dyspepsia and heartburn: a cost comparison. Author(s): Goulston KJ, Dent OF, Mant A, Logan J, Ngu M. Source: The Medical Journal of Australia. 1991 July 1; 155(1): 20-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1676825&dopt=Abstract

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Use of non-antacid antiulcer agents in the treatment of heartburn and dyspepsia. Author(s): Sena MM, Stoddard ML, Pashko S. Source: Clinical Therapeutics. 1994 January-February; 16(1): 103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8205596&dopt=Abstract

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What is heartburn worth? A cost-utility analysis of management strategies. Author(s): Heudebert GR, Centor RM, Klapow JC, Marks R, Johnson L, Wilcox CM. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2000 March; 15(3): 175-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718898&dopt=Abstract

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What is the best pharmacologic approach to managing moderate to severe heartburn? Author(s): Melton ST, Cimmino A. Source: The Journal of Family Practice. 2001 October; 50(10): 839. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11674880&dopt=Abstract

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What medications are safe and effective for heartburn during pregnancy? Author(s): Marquardt DN. Source: The Journal of Family Practice. 2001 April; 50(4): 304-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11300980&dopt=Abstract

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When doctors go to class, industry often foots the bill: lectures tend to feature pills made by course sponsors; companies deny influence; a purple heartburn brochure. Author(s): Hensley S. Source: Wall St J (East Ed). 2002 December 4; : A1, A12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653117&dopt=Abstract

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When does heartburn warrant more concern? Author(s): Walsh JH. Source: Gastroenterology. 1999 August; 117(2): 293. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10465629&dopt=Abstract

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When your patients ask about nasty heartburn. Author(s): Trimmer E. Source: Midwife Health Visit Community Nurse. 1985 January; 21(1): 24. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3844046&dopt=Abstract

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CHAPTER 2. NUTRITION AND HEARTBURN Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and heartburn.

Finding Nutrition Studies on Heartburn The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “heartburn” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “heartburn” (or a synonym): •

ABC of the upper gastrointestinal tract: Oesophagus: heartburn. Source: de Caestecker, J BMJ. 2001 September 29; 323(7315): 736-9 0959-8138

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Clinical effectiveness of a new antacid chewing gum on heartburn and oesophageal pH control. Author(s): Oklahoma Foundation for Digestive Research, Oklahoma City 73104, USA. Source: Collings, K L Rodriguez Stanley, S Proskin, H M Robinson, M Miner, P B Jr Aliment-Pharmacol-Ther. 2002 December; 16(12): 2029-35 0269-2813

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Effects of antacid formulation on postprandial oesophageal acidity in patients with a history of episodic heartburn. Author(s): Oklahoma Foundation for Digestive Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Source: Robinson, M Rodriguez Stanley, S Miner, P B McGuire, A J Fung, K Ciociola, A A Aliment-Pharmacol-Ther. 2002 March; 16(3): 435-43 0269-2813

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Heartburn: community perceptions. Author(s): The Gut Foundation, Prince of Wales Hospital, Randwick, New South Wales, Australia. [email protected] Source: Bolin, T D Korman, M G Hansky, J Stanton, R J-Gastroenterol-Hepatol. 2000 January; 15(1): 35-9 0815-9319

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Low dose famotidine in the prevention of sleep disturbance caused by heartburn after an evening meal. Author(s): Medical, Regulatory and Technical Group, J&J MSD Europe, High Wycombe, Buckinghamshire, UK. Source: Mann, S G Murakami, A McCarroll, K Rao, A N Cottrell, J Mehentee, J Morton, R Aliment-Pharmacol-Ther. 1995 August; 9(4): 395-401 0269-2813

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Management of heartburn in a large, randomized, community-based study: comparison of four therapeutic strategies. Author(s): Northwestern University Medical School, Chicago, Illinois, USA. Source: Howden, C W Henning, J M Huang, B Lukasik, N Freston, J W Am-JGastroenterol. 2001 June; 96(6): 1704-10 0002-9270

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Managing heartburn at the 'base' of the GERD 'iceberg': effervescent ranitidine 150 mg b.d. provides faster and better heartburn relief than antacids. Author(s): University of Arizona Health Sciences Center, Tucson, AZ, USA. Source: Earnest, D Robinson, M Rodriguez Stanley, S Ciociola, A A Jaffe, P Silver, M T Kleoudis, C S Murdock, R H Aliment-Pharmacol-Ther. 2000 July; 14(7): 911-8 0269-2813

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Meal type affects heartburn severity. Author(s): The Oklahoma Foundation for Digestive Research, The University of Oklahoma Health Sciences Center, Oklahoma City 73104-5022, USA. Source: Rodriguez, S Miner, P Robinson, M Greenwood, B Maton, P N Pappa, K DigDis-Sci. 1998 March; 43(3): 485-90 0163-2116

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Prevention of heartburn relapse by low-dose famotidine: a test meal model for duration of symptom control. Author(s): Clinical Research and Development Group, J & J MSD Europe, High Wycombe, Buckinghamshire, UK. Source: Mann, S G Cottrell, J Murakami, A Stauffer, L Rao, A N Aliment-PharmacolTher. 1997 February; 11(1): 121-7 0269-2813

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Randomised controlled trial of pantoprazole versus ranitidine for the treatment of uninvestigated heartburn in primary care. Author(s): University of Sydney, Nepean Hospital, PO Box 63, Penrith, NSW 2751, Australia. [email protected] Source: Talley, N J Moore, M G Sprogis, A Katelaris, P Med-J-Aust. 2002 October 21; 177(8): 423-7 0025-729X

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Relationships between the acidity and osmolality of popular beverages and reported postprandial heartburn. Author(s): University of Texas Southwestern Medical School at Dallas. Source: Feldman, M Barnett, C Gastroenterology. 1995 January; 108(1): 125-31 0016-5085

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Remedies for common family ailments: 1. Indigestion and heartburn. Source: Sinclair, A Prof-Care-Mother-Child. 1994 Jan-February; 4(1): 23-4 0964-4156

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to heartburn; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Pantothenic Acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,882,00.html Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html

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Minerals Betaine Hydrochloride Source: Healthnotes, Inc.; www.healthnotes.com Betaine Hydrochloride Source: Prima Communications, Inc.www.personalhealthzone.com Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Lecithin and Choline Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10040,00.html Quercetin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10053,00.html

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Food and Diet Chocolate Source: Healthnotes, Inc.; www.healthnotes.com Cinnamon Alternative names: Cinnamomum zeylanicum Source: Healthnotes, Inc.; www.healthnotes.com Coffee Source: Healthnotes, Inc.; www.healthnotes.com Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Garlic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,786,00.html Juices Source: Healthnotes, Inc.; www.healthnotes.com Tea Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND HEARTBURN Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to heartburn. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to heartburn and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “heartburn” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to heartburn: •

A trial of deglycyrrhizinated liquorice in the treatment of duodenal ulcer. Author(s): Feldman H, Gilat T. Source: Gut. 1971 June; 12(6): 449-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4933135&dopt=Abstract

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A yoga teacher with persistent reflux symptoms. Author(s): Biswas R, Paul A, Shetty KJ. Source: Int J Clin Pract. 2002 November; 56(9): 723. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12469992&dopt=Abstract

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Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. Author(s): Maton PN, Burton ME.

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Source: Drugs. 1999 June; 57(6): 855-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10400401&dopt=Abstract •

Commentary on common alimentary symptoms. Author(s): Jones FA. Source: Trans Med Soc Lond. 1965; 81: 126-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5825320&dopt=Abstract

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Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication--a placebo-controlled, double-blind multicenter trial. Author(s): Peters H, Kieser M, Holscher U. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 1998 May; 27(2): 106-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9612115&dopt=Abstract

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Do side-effects reduce compliance to iron supplementation? A study of daily- and weekly-dose regimens in pregnancy. Author(s): Hyder SM, Persson LA, Chowdhury AM, Ekstrom EC. Source: J Health Popul Nutr. 2002 June; 20(2): 175-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12186198&dopt=Abstract

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Dyspepsia as a somatic expression of guilt: a case report. Author(s): Zimmerman J. Source: Am J Clin Hypn. 2001 July; 44(1): 57-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11417148&dopt=Abstract

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Efficacy of a pectin-based anti-reflux agent on acid reflux and recurrence of symptoms and oesophagitis in gastro-oesophageal reflux disease. Author(s): Havelund T, Aalykke C, Rasmussen L. Source: European Journal of Gastroenterology & Hepatology. 1997 May; 9(5): 509-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9187886&dopt=Abstract

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Endoluminal therapies for gastro-oesophageal reflux disease. Author(s): Galmiche JP, Bruley des Varannes S. Source: Lancet. 2003 March 29; 361(9363): 1119-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12672327&dopt=Abstract

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Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. Author(s): Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK.

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Source: Journal of Gastroenterology. 1997 December; 32(6): 765-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9430014&dopt=Abstract •

Folate supplementation in methotrexate-treated rheumatoid arthritis patients. Author(s): Stewart KA, Mackenzie AH, Clough JD, Wilke WS. Source: Seminars in Arthritis and Rheumatism. 1991 April; 20(5): 332-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2068578&dopt=Abstract

•

Functional heartburn. Author(s): Tack J, Janssens J. Source: Current Treatment Options in Gastroenterology. 2002 August; 5(4): 251-258. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095472&dopt=Abstract

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Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Author(s): Boozer CN, Daly PA, Homel P, Solomon JL, Blanchard D, Nasser JA, Strauss R, Meredith T. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2002 May; 26(5): 593-604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12032741&dopt=Abstract

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Indigestion and heartburn: a descriptive study of prevalence in persons seeking care from chiropractors. Author(s): Bryner P, Staerker PG. Source: Journal of Manipulative and Physiological Therapeutics. 1996 June; 19(5): 317-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8792321&dopt=Abstract

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Lack of effects of copper gluconate supplementation. Author(s): Pratt WB, Omdahl JL, Sorenson JR. Source: The American Journal of Clinical Nutrition. 1985 October; 42(4): 681-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2931973&dopt=Abstract

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Navoban (tropisetron, ICS 205-930) and dexamethasone combination in the prevention of vomiting for patients receiving preconditioning high-dose chemotherapy before marrow transplantation. Author(s): Yen CC, Hsieh RK, Chiou TJ, Liu JH, Fang FS, Wang WS, Tung SL, Tzeng CH, Chen PM. Source: Japanese Journal of Clinical Oncology. 1998 February; 28(2): 129-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9544829&dopt=Abstract

•

Oral hyposensitization in patients with contact dermatitis from Parthenium hysterophorus. Author(s): Handa S, Sahoo B, Sharma VK.

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Source: Contact Dermatitis. 2001 May; 44(5): 279-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11298693&dopt=Abstract •

Pharmacokinetics and safety of green tea polyphenols after multiple-dose administration of epigallocatechin gallate and polyphenon E in healthy individuals. Author(s): Chow HH, Cai Y, Hakim IA, Crowell JA, Shahi F, Brooks CA, Dorr RT, Hara Y, Alberts DS. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2003 August 15; 9(9): 3312-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960117&dopt=Abstract

•

Power of oesophageal peristalsis can be controlled voluntarily. Author(s): Valori RM, Hallisey MT, Dunn J. Source: Gut. 1991 March; 32(3): 236-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2013416&dopt=Abstract

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Prolonged remissions of metastatic breast cancer achieved with a six-drug regimen of relatively low toxicity. Author(s): Hirshaut Y, Kesselheim H. Source: Cancer. 1983 June 1; 51(11): 1998-2004. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6687698&dopt=Abstract

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Psyllium for the reduction of cholestyramine-associated gastrointestinal symptoms in the treatment of primary hypercholesterolemia. Author(s): Maciejko JJ, Brazg R, Shah A, Patil S, Rubenfire M. Source: Archives of Family Medicine. 1994 November; 3(11): 955-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7804477&dopt=Abstract

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Randomized controlled trial of Syn-Ergel and an active placebo in the treatment of heartburn of pregnancy. Author(s): Shaw RW. Source: J Int Med Res. 1978; 6(2): 147-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=344087&dopt=Abstract

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Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy. Author(s): Shay SS, Johnson LF, Wong RK, Curtis DJ, Rosenthal R, Lamott JR, Owensby LC. Source: Journal of Clinical Gastroenterology. 1986 April; 8(2): 115-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3462241&dopt=Abstract

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•

The effect of a sports drink on gastroesophageal reflux during a run-bike-run test. Author(s): Peters HP, Wiersma JW, Koerselman J, Akkermans LM, Bol E, Mosterd WL, de Vries WR. Source: International Journal of Sports Medicine. 2000 January; 21(1): 65-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10683102&dopt=Abstract

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The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Author(s): Wigler I, Grotto I, Caspi D, Yaron M. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2003 November; 11(11): 783-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14609531&dopt=Abstract

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The efficacy of a pectin-based raft-forming anti-reflux agent in endoscopy-negative reflux disease. Author(s): Havelund T, Aalykke C. Source: Scandinavian Journal of Gastroenterology. 1997 August; 32(8): 773-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9282968&dopt=Abstract

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The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Author(s): Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH, Anderson PK, Wolfe MM, Rothstein RI, Wo JM, Corley DA, Patti MG, Antignano LV, Goff JS, Edmundowicz SA, Castell DO, Rabine JC, Kim MS, Utley DS. Source: Gastrointestinal Endoscopy. 2002 February; 55(2): 149-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818914&dopt=Abstract

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Unusual hepatic visualization after esophageal scintigraphy. Author(s): Valenza V, Reale F, Porziella V, Marchese M, Granone P, D'Errico G. Source: Clinical Nuclear Medicine. 2002 December; 27(12): 932-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607894&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to heartburn; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Alcoholism Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Cancer Prevention (reducing the Risk) Source: Prima Communications, Inc.www.personalhealthzone.com Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com Cough Source: Integrative Medicine Communications; www.drkoop.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Gastritis Source: Healthnotes, Inc.; www.healthnotes.com Gastritis Source: Integrative Medicine Communications; www.drkoop.com Gastroesophageal Reflux Disease Source: Healthnotes, Inc.; www.healthnotes.com Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.drkoop.com Heartburn Source: Integrative Medicine Communications; www.drkoop.com

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High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Integrative Medicine Communications; www.drkoop.com Irritable Bowel Syndrome Alternative names: Spastic Colon Source: Prima Communications, Inc.www.personalhealthzone.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Schizophrenia Source: Healthnotes, Inc.; www.healthnotes.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com Sinus Infection Source: Integrative Medicine Communications; www.drkoop.com Sinusitis Source: Integrative Medicine Communications; www.drkoop.com Sleeplessness Source: Integrative Medicine Communications; www.drkoop.com Stomach Inflammation Source: Integrative Medicine Communications; www.drkoop.com Tension Headache Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html Osteopathy Source: Integrative Medicine Communications; www.drkoop.com

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Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html Testing for Stomach Acidity Source: Healthnotes, Inc.; www.healthnotes.com •

Herbs and Supplements 5-htp Source: Integrative Medicine Communications; www.drkoop.com 5-hydroxytryptophan (5-htp) Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10001,00.html Aluminum Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Andrographis Alternative names: Andrographis paniculata Source: Healthnotes, Inc.; www.healthnotes.com Angkak Source: Integrative Medicine Communications; www.drkoop.com Baking Soda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,835,00.html Beni-koji Source: Integrative Medicine Communications; www.drkoop.com Beta-carotene Source: Prima Communications, Inc.www.personalhealthzone.com Blessed Thistle Alternative names: Cnicus benedictus Source: Healthnotes, Inc.; www.healthnotes.com Boldo Alternative names: Peumus boldus Source: Healthnotes, Inc.; www.healthnotes.com

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Bromelain Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,760,00.html Cayenne Alternative names: Capsicum annuum, Capsicum frutescens Source: Healthnotes, Inc.; www.healthnotes.com Chamaemelum Nobile Source: Integrative Medicine Communications; www.drkoop.com Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com Chamomile Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,766,00.html Chaparral Alternative names: Larrea tridentata Source: Healthnotes, Inc.; www.healthnotes.com Cimetidine Source: Healthnotes, Inc.; www.healthnotes.com Cisapride Source: Healthnotes, Inc.; www.healthnotes.com Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10021,00.html Devil’s Claw Alternative names: Harpagophytum procumbens Source: Healthnotes, Inc.; www.healthnotes.com Devil's Claw Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,970,00.html Digestive Enzymes Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10051,00.html Famotidine Source: Healthnotes, Inc.; www.healthnotes.com Fennel Alternative names: Foeniculum vulgare Source: Healthnotes, Inc.; www.healthnotes.com Gamma-oryzanol Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10028,00.html Gentian Alternative names: Gentiana lutea Source: Healthnotes, Inc.; www.healthnotes.com Gentian Source: Prima Communications, Inc.www.personalhealthzone.com German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Integrative Medicine Communications; www.drkoop.com Ginger Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787,00.html Glucosamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,790,00.html Hong Qu Source: Integrative Medicine Communications; www.drkoop.com Hung-chu Source: Integrative Medicine Communications; www.drkoop.com Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798,00.html Lactase Source: Healthnotes, Inc.; www.healthnotes.com Lavender Alternative names: Lavandula officinalis Source: Healthnotes, Inc.; www.healthnotes.com Lemon Balm Alternative names: Melissa officinalis Source: Healthnotes, Inc.; www.healthnotes.com Licorice Alternative names: Glycyrrhiza glabra, Glycyrrhiza uralensis Source: Healthnotes, Inc.; www.healthnotes.com Licorice Source: Prima Communications, Inc.www.personalhealthzone.com Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,801,00.html Lobelia Alternative names: Lobelia inflata Source: Healthnotes, Inc.; www.healthnotes.com Marshmallow Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10042,00.html Matricaria Recutita Source: Integrative Medicine Communications; www.drkoop.com Meadowsweet Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Mentha X Piperita Source: Integrative Medicine Communications; www.drkoop.com Metoclopramide Source: Healthnotes, Inc.; www.healthnotes.com Monascus Source: Integrative Medicine Communications; www.drkoop.com

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Nizatidine Source: Healthnotes, Inc.; www.healthnotes.com Peppermint Alternative names: Mentha piperita Source: Healthnotes, Inc.; www.healthnotes.com Peppermint Alternative names: Mentha x piperita Source: Integrative Medicine Communications; www.drkoop.com Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812,00.html Phenylalanine Source: Healthnotes, Inc.; www.healthnotes.com Ranitidine Source: Healthnotes, Inc.; www.healthnotes.com Red Koji Source: Integrative Medicine Communications; www.drkoop.com Red Leaven Source: Integrative Medicine Communications; www.drkoop.com Red Rice Source: Integrative Medicine Communications; www.drkoop.com Red Yeast Rice Alternative names: Monascus purpureus Source: Healthnotes, Inc.; www.healthnotes.com Red Yeast Rice Alternative names: Angkak, Beni-koju, Hong Qu, Hung-chu, Monascus, Red Leaven, Red Rice, Red Koji, Zhitai, Xue Zhi Kang Source: Integrative Medicine Communications; www.drkoop.com Red Yeast Rice Source: Prima Communications, Inc.www.personalhealthzone.com Red Yeast Rice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10054,00.html Roman Chamomile Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.drkoop.com

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SAMe (S-Adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818,00.html Slippery Elm Alternative names: Ulmus rubra, Ulmus fulva Source: Healthnotes, Inc.; www.healthnotes.com Slippery Elm Source: Prima Communications, Inc.www.personalhealthzone.com Slippery Elm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10056,00.html Wormwood Alternative names: Artemisia absinthium Source: Healthnotes, Inc.; www.healthnotes.com Yarrow Alternative names: Achillea millefolium Source: Healthnotes, Inc.; www.healthnotes.com Zhitai Source: Integrative Medicine Communications; www.drkoop.com Zingiber Officinale Source: Integrative Medicine Communications; www.drkoop.com Zue Zhi Kang Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON HEARTBURN Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “heartburn” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on heartburn, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Heartburn By performing a patent search focusing on heartburn, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on heartburn: •

Antacid pharmaceutical composition Inventor(s): Buch; R. Michael (Randolph, NJ), Engelman; E. Eric (Budd Lake, NJ), Georgiades; Constantine (East Brunswick, NJ), Volpe; Frank A. (Kinnelon, NJ) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 5,762,962 Date filed: October 5, 1994 Abstract: Antacid pharmaceutical compositions provide optimal buffering profiles of from 3.0 to 5.0 for immediate and long lasting relief from the symptoms of acid indigestion, sour stomach, heartburn and gas. The composition may comprise a dual or tripartite combination of the actives calcium carbonate, calcium or magnesium citrate and/or calcium phosphate which, as a result of their different activities, neutralize the excess stomach acid both immediately and continuously over time. The formulations also provide the individual with alternative dosage forms which may provide greater levels of calcium, less sodium and less production of gastrointestinal gas. Excerpt(s): The present invention relates generally to pharmaceutical compositions comprising active agents useful in the treatment of upper gastrointestinal disorders such as what is commonly referred to as sour stomach, upset stomach, heartburn, gas, acid indigestion and the like. Pharmaceutical compositions containing antacid agents useful for treating gastrointestinal problems are widely used and have been around for quite some time. They vary to some extent in the active ingredients and other excipients and increasingly vary with respect to the other ingredients used that are responsible for flavor, texture, mouthfeel and mechanisms of delivery. H.sup.+ (acid)+CaCO.sub.3.fwdarw.HCO.sub.3.sup.- +Ca.sup.++ 1. H.sup.+ +HCO.sub.3.sup..fwdarw.H.sub.2 O+CO.sub.2.uparw.2. Web site: http://www.delphion.com/details?pn=US05762962__

•

Antioxidant composition and method for the same Inventor(s): Fujie; Hisanao (Kobe, JP) Assignee(s): A.O.A. Japan Co., Ltd. (Hyogo, JP) Patent Number: 5,498,412 Date filed: October 11, 1994 Abstract: A natural antioxidant composition made from a plurality of fermented and milled materials of edible grains and pulses and an embryo or bran of the grains, is produced by a process comprising the steps of: parching a plurality of kinds of edible grains and pulses and an embryo or bran of the grains and pulses respectively; milling the parched resultants separately; steaming the milled resultants separately; molting the steamed resultants separately with fermentations; adding alcohol to the malted resultants separately to restrict the fermentations; drying the resultants separately to remove the alcohol; mixing all of the resultants to make a first mixture fermented; parching an edible seed and a green tea leave separately; milling the parched seed and the parched green tea leave separately; mixing the parched seed and the parched green tea leave to make a second mixture of mash; mixing the first and second mixtures to a

Patents 59

mature material; and granulating the mature material to granules, thereby being easily digested in the aged human body without pyrosis or heartburn. Excerpt(s): The present invention relates to a natural antioxidant composition, more particularly to a natural antioxidant composition of a processed grain food used for maintaining human health and preventing from diseases so to assist a medical treatment. It is believed in the field of medicine and biochemistry that one of the causes of maturity-onset diseases such as arteriosclerosis, cancer, cardiopathy, diabetes mellitus is due to active oxygens or its free radicals (hereinafter referred as "active oxygen") generated in the tissues or cells of a living body. The relationship between the disease and the active oxygen has been studied. The active oxygen causes merits and demerits in the living tissue. Namely, the active oxygen at a adequate amount performs a part of the defensive mechanism against an infection. On the other hand, when the active oxygen excessively generated in the tissue, such surplus active oxygen causes a reaction of lipid peroxidation by means of non-control denatures nucleic acids and proteins. As a result, the surplus active oxygen becomes the causes of diseases of adult people and incurable diseases. This surplus active oxygen is a great problem as unnecessary oxidation in the living tissue. For this, the inhibiting enzymes effectively preventing such a so-call toxicity of active oxygen are generated in the living tissue. Superoxide dismutase (hereinafter referred as "SOD") is well known as one of the inhibiting enzymes. There is a treatment method for curing the disease by injecting SOD into the living tissue. SOD is administered only by means of the subcutaneous injection. The duration of effect of SOD is only for about ten minutes. The effect of SOD is not confirmed, when SOD is used in the form of an oral medicine. The advantageous effect of SOD is restricted, so that it is effective against only the disease caused by lacks of SOD. There are six kinds of active oxygens concerning the reaction of lipid peroxidation and the other four kinds. Web site: http://www.delphion.com/details?pn=US05498412__ •

Arginine/ascorbic acid mixed powder as an oral supplement Inventor(s): Kimoto; Eiji (Jonan-ku, JP), Morishige; Fukumi (2-10-13, Miyakono, Oamishirasato-machi, Sanbu-gun, Chiba-ken, JP) Assignee(s): Kimoto; Sachiko (Jonan-ku, JP), Morishige; Fukumi (Sanbu-gun, JP) Patent Number: 6,552,074 Date filed: November 13, 2001 Abstract: A mixture obtained by mixing ascorbic acid powder with arginine powder in a weight ratio (ascorbic acid/arginine) of 1/5 to 20, especially 1/5 to 1/4; and a supplement such as a nutrient preparation and a health-care food containing the mixture. Mixing of arginine powder and ascorbic acid powder in the weight ratios eliminates stringent taste specific to arginine and alleviates stringent feeling in the stomach (heartburn, nausea or vomiting) after oral intake thereof. The mixture prevents also peroxidative injuries of cells caused by an administration of a great amount of arginine alone. Further, mixing of arginine powder with ascorbic acid powder prevents browning of the mixture after long-term storage. Excerpt(s): The present invention relates to a method for eliminating the stringent taste and alleviating stringent feeling in the stomach of L-arginine (hereinafter referred to as arginine) by mixing L-ascorbic acid (hereinafter referred to as ascorbic acid) and for alleviating the toxicity of arginine-derived NO radical by arginine-ascorbic acid-

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combined treatment. From late 1970's to 1980's, a research group of Illinois University reevaluated that dietary arginine is indispensable for optimal health of adult and especially aged humans. (see E. Kimoto, "Nutritional Chemistry of L-Arginine", Kaisei Publishing Co. Ltd., Tokyo, 1999 (Literature 2), page 93). In 1987, it was reported that NO radical participating in a wide variety of physiological functions such as blood pressure control and prevention of infections is derived from arginine as a source. This led to increased attention paid to arginine in the field of amino acid nutrition science (see Literature 2, page 57). Web site: http://www.delphion.com/details?pn=US06552074__ •

Bed angle-elevators Inventor(s): Styblo; Norbert (33 Tremont St., Carver, MA 02330) Assignee(s): none reported Patent Number: 5,199,122 Date filed: April 8, 1992 Abstract: An extension or elevator device for the legs supporting bed-frames of various design, which are arranged to raise the head of the bed. The resultant pitching of the sleeping surface is to reduce stomach acid reflux into the esophagus in the condition Reflux Esophagitis (commonly: heartburn) during bedrest. Device is installed in place of casters or gliders, and has provision for replacing casters in order to retain the original floor-bearing and mobility characteristics of the bed. Excerpt(s): The present invention relates to beds, specifically to devices which may be applied to the legs of bedframes for the purpose of extension, in a configuration resulting in the angling of the sleeping-surface. Reflux Esophagitis (commonly: heartburn) is a painful medical condition typically caused by the reflux of stomach acid into the esophagus. Discomfort can be acute and persistent, particularly to people suffering from a hiatus hernia. Due to the relative position of stomach and esophagus, lying flat in bed usually increases the likelihood of acid reflux, and the discomfort it causes. A common solution recommended by the medical profession for pain relief during bedrest is to elevate the head of the patient's bed four or five inches (10 or 12.7 cm.), thereby angling the sleeping surface to physically prevent acid reflux. Usually this is followed by a suggestion for the patient to improvise some sort of blocking under the bed legs of appropriate height to accomplish this end. While a simple and effective solution, this method can be unstable, can cause damage to floor finishes, and negates the usefulness of casters or gliders for facilitating bed mobility. Web site: http://www.delphion.com/details?pn=US05199122__

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Composition and method for increasing the pH of acid foods Inventor(s): Hartzell; Sarah (Mays Landing, NJ), Kligerman; Alan E. (Linwood, NJ) Assignee(s): Akpharma Inc. (Pleasantville, NJ) Patent Number: 5,665,415 Date filed: July 26, 1995 Abstract: A method is provided for increasing the pH of acidic foods and beverages, to thereby reduce the tendency of such foodstuffs to cause heartburn and other

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gastrointestinal distress to the consumer. An acidic food or beverage, such as coffee, is combined with an amount of calcium glycerophosphate (CGP) effective to raise the pH of the food or beverage, preferably by at least about 0.5 pH units, and more preferably to a pH of between about 5.4 and 7.0. Edible compositions including CGP, having a pH of greater than about 5.4 are obtained. The CGP may also be added to acidic foods to remove the biting flavor that such foods have, and thus CGP serves as a flavor modulator. Packages comprising CGP inside a container, where the container may be easily opened to provide a single dose of CGP, are useful in the method and in forming the edible compositions. Excerpt(s): The invention relates to foods and beverages, and particularly to methods of increasing the pH of acidic foods and beverages to ameliorate heartburn and other illeffects attendant eating and ingesting such foodstuffs. The invention provides ingestible compositions having reduced acidity, and packages useful in preparing the compositions. Most people enjoy eating and drinking acidic foods and beverages (referred to generically herein as "food" or "foods"), where pizza, coffee and wine are common examples of popular acidic foods. However, for some people, the ingestion of acidic foods has undesirable consequences. For example, the acid in acidic food such as wine is perceived as a sharp taste, or bite, when that food is taken into a consumer's mouth. For some people, acidic food has too much bite, and thus is less palatable than would be preferred. Also, some people suffer from heartburn after ingesting even moderate amounts of acidic food. A problem attendant to ingesting large quantities of acidic food is that the consumer's stomach may reach dangerously low pH levels over an extended period of time, because of the sheer quantity of exogenous acid ingested, and this can lead to ulcers or other gastrointestinal tract ailments. According to one medical dictionary, heartburn is an esophageal symptom consisting of a retrosternal sensation of warmth or burning occurring in waves and tending to rise upward toward the neck. It may take the form of water brash, where water brash is heartburn including regurgitation of sour fluid or almost tasteless saliva into the mouth. See Dorland's Illustrated Medical Dictionary, 28th Edition, 1994 (W.B. Saunders Co.). When people develop heartburn, they may ingest antacids, that are available over-the-counter, to help neutralize the stomach acid. Web site: http://www.delphion.com/details?pn=US05665415__ •

Foaming antacid suspension tablets Inventor(s): Bauer; Kurt H. (Freiburg, DE) Assignee(s): DR. Regenold GmbH (Badenweiler, DE) Patent Number: 6,589,507 Date filed: August 13, 2001 Abstract: The invention relates to antacid preparations comprising the following constituents:(i) an acid-binding active constituent (antacid) or a mixture of such active constituents,(ii) an effervescent mixture that releases CO.sub.2,(iii) a polymeric surfactant as foam-forming agent or a mixture of such surfactants,(iv) a swellable and gel-forming polymer or a mixture of such polymers, and(v) optionally conventional auxiliary substances,as well as a process for the production of such antacid preparations. In a particularly preferred embodiment the antacid preparation is formulated in the form of a chewable tablet. The antacid preparations according to the invention are suitable for the symptomatic treatment of duodenal ulcers, gastric ulcers, as well as heartburn and acid-caused gastric disorders such as hyperacidic gastritis.

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Excerpt(s): The present invention relates to preparations that contain one or more acidbinding active constituents (antacids), as well as a process for the production of these preparations and their use as medicaments for the regulation of gastric hyperacidity. Therapy with antacids has proved outstandingly successful for the treatment of a number of acute and chronic gastro-intestinal conditions. In particular, antacids are used for the symptomatic treatment of duodenal and gastric ulcers as well as in heartburn and acid-caused gastric disorders such as hyperacidic gastritis. The action of the antacids basically depends on the fact that the gastric hydrochloric acid is to some extent buffered so that the pH of the stomach is increased from 1 to 2 or 3, or even 4. Due to this increase in the pH value the symptoms typical of hyperacidity, such as for example a feeling of fullness or heartburn, are reduced or even eliminated. Up to now antacids have been marketed and sold in powder form, as normal tablets, predominantly as chewable tablets or as suspensions in bottles or packed in sachets. In German patent application DE 44 24 676 antacid effervescent tablets are also described. The known chewable tablets can be administered extremely easily and simply, but have the disadvantage that the patient finds that these tablets are chalky and thus unpleasant after they have been chewed. In contrast to this the known, finely dispersed suspension medicament forms are not perceived as being chalky, are well tolerated, and are furthermore characterised by a rapid and clearly detectable onset of action and effect. The disadvantage of these suspension medicament forms is however the fact that elderly patients in particular have difficulty in removing the suspensions completely and without too much effort from the sachet packagings. On the other hand the formulation and administration of effervescent tablets is simpler, although the effervescent tablets used up to now have to be taken with a glass of water, in which the effervescent tablets dissolve with foaming to form a liquid drinkable suspension. For this reason it is not possible to take the medicament at every opportunity. Accordingly, all the hitherto available preparation forms of antacids have certain disadvantages as regards their administration. Web site: http://www.delphion.com/details?pn=US06589507__ •

Heartburn and reflux disease treatment with controlled wireless energy supply Inventor(s): Forsell; Peter (Menzingen, CH) Assignee(s): Obtech Medical AG (Baar, CH) Patent Number: 6,450,173 Date filed: February 10, 2000 Abstract: A heartburn and reflux disease treatment apparatus and method includes and uses an operable restriction device implanted in a patient and engaging the stomach close to the cardia or engaging the esophagus to form a restricted passageway in the stomach or esophagus. A source of energy external to the patient's body and a control device for releasing wireless energy from the source of energy from outside the patient's body are provided, so that the released wireless energy is used in connection with the operation of the restriction device to enlarge or contract the passageway. Excerpt(s): The present invention relates to a heartburn and reflux disease treatment apparatus and method. More specifically, the invention relates to a heartburn and reflux disease treatment apparatus and method for surgical application in the abdomen of a patient for forming a restricted food passageway in the esophagus or stomach. The term "patient" includes an animal or a human being. Chronic heartburn and reflux disease is a widespread medical problem. This is often due to hiatal hernia, i.e. a portion of the

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stomach immediately below the gastric fundus slides upwardly through the esophageal hiatus. In consequence, stomach acids and foods are regurgitated into the esophagus. In the late 1970s a prior art prosthesis called Angelchik, according to U.S. Pat. No. 3,875,928, was used to operatively treat heartburn and reflux disease. However, the Angelchik prosthesis had a major disadvantage in that it was not possible to adjust the size of the restriction opening after the operation. A further disadvantage was that the prosthesis did not satisfactorily protect the esophagus and the surrounding area against injuries due to poor shape of the prosthesis. Therefore, operations using the Angelchik prosthesis are no longer practiced. Web site: http://www.delphion.com/details?pn=US06450173__ •

Heartburn treatment Inventor(s): Berlin; Roger (Haverford, PA), Simon; Thomas (Berwyn, PA) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 5,667,794 Date filed: September 11, 1996 Abstract: A method for treating a patient suffering from heartburn and having no substantial esophageal erosion, comprising administering to the patient a composition comprising an amount of famotidine between about 5 mg and 10 mg. In one embodiment, the amount of famotidine is about 5 mg. In another embodiment, the amount of famotidine is about 10 mg.A method for treating a patient suffering from heartburn and having no substantial esophageal erosion, comprising administering to the patient a composition comprising an amount of famotidine between about 5 mg and 10 mg, and an antacid. In one embodiment, the amount of famotidine is about 5 mg. In another embodiment, the amount of famotidine is about 10 mg. Excerpt(s): Heartburn, or pyrosis, is a sensation of pain or burning located substernally or high in the epigastrium with radiation into the neck and occasionally to the arms, associated with regurgitation of acid-peptic gastric juice into the esophagus. Occassional heartburn is common in normal persons, but frequent and severe heartburn is generally a manifestation of esophageal dysfunction. Heartburn may result from abnormal motor activity or distention of the esophagus relfux of acid or bile into the esophagus, or direct esophageal mucosa irritation (esophagitis). Heartburn is most often associated with gastroesophageal reflux. In this setting, heartburn typically occurs after a meal, with stooping or bending, or when the patient is supine. It may be accompanied by the spontaneous appearance in the mouth of fluid which may be salty, sour, or bitter and green or yellow. Heartburn may arise following the ingestion of certain foods (e.g. citrus fruit juices) or drugs (e.g. alcohol or aspirin). Characteristically, heartburn is alleviated promptly, even if only temporarily, by antacids. Heartburn may also occur in the absence of a demonstrated anatomic or physiologic condition. In this setting, it is frequently accompanied by aerophagia, which may represent an attempt by the patient to relieve discomfort, and is often attributed to psychological factors for lack of other explanations. Web site: http://www.delphion.com/details?pn=US05667794__

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Ibuprofen antacid combinations Inventor(s): Gates; Thomas N. (Doylestown, PA), Sims; Robert T. (Holicong, PA), Slivka; William (Philadelphia, PA) Assignee(s): McNeill-PPC, Inc. (Fort Washington, PA), Merck & Co., Inc. (Rahway, NJ) Patent Number: 5,288,507 Date filed: July 29, 1992 Abstract: This invention relates to a pharmaceutical composition for use in the treatment of pain and inflammation and the treatment of acid indigestion, sour stomach, heartburn and symptoms of upset stomach associated with these conditions in a mammalian organism, said composition comprising:(i) an analgesically and antiinflammatory effective amount of (S)-ibuprofen, or a salt thereof, substantially free of (R)-ibuprofen;(ii) an amount effective in the treatment of acid indigestion, sour stomach and/or heartburn of at least one of the antacids; and(iii) optionally, an amount effective in treating excess gas and flatulence of an anti-gas agent. Excerpt(s): The non-steroidal anti-inflammatory drugs (NSAID) have been utilized in the treatment of pain/inflammation and have been disclosed as useful in the treatment, management and mitigation of cold symptoms and the pain associated therewith. Ibuprofen (2-(4-isobutylphenyl)propionic acid) is a well known and commonly employed NSAID. Recently, it has been found that a faster onset of pain relief and an enhanced analgesic response can be obtained by the utilization of the single enantiomer (S)-ibuprofen in comparison to racemic ibuprofen, (see for example U.S. Pat. No. 4,877,620). Antacids are useful for the treatment of acid indigestion, heartburn, sour stomach, and symptoms of upset stomach associated with these conditions. Antacids work by neutralizing the excess stomach acid, thereby preventing inflammation, relieving pain, and allowing the mucous layer and lining to mend. In optional combination with an anti-gas agent, such as simethicone, antacids may offer relief or reduction of flatuence. Anti-gas remedies have a defoaming action that relieves or reduces flatulence by dispersing and preventing the formation of mucous-surrounded gas pockets in the gastrointestinal tract. Additionally, products which are combined with alginates float on the contents of the stomach and produce a neutralizing layer to subdue acid that can rise into the esophagus, causing heartburn. Web site: http://www.delphion.com/details?pn=US05288507__

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Method for preventing heartburn Inventor(s): Berlin; Roger (Haverford, PA), Gates; Thomas N. (Bonita Springs, FL), Simon; Thomas (Berwyn, PA) Assignee(s): Mc Neil-PPC, Inc. (Skillman, NJ), Merck & Co., Inc. (Rahway, NJ) Patent Number: 5,854,267 Date filed: June 2, 1995 Abstract: A method for preventing heartburn episodes in a patient susceptible to suffering heartburn episodes following ingestion of heartburn-inducing food or beverage, comprising administering to the patient, 30 minutes prior to consumption by the patient of the food or beverage, a composition comprising an amount of famotidine of 10 mg.

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Excerpt(s): Heartburn, or pyrosis, is a sensation of pain or burning located substernally or high in the epigastrium with radiation into the neck and occasionally to the arms, associated with regurgitation of acid-peptic gastric juice into the esophagus. Occasional heartburn is common in normal persons, but frequent and severe heartburn is generally a manifestation of esophageal dysfunction. Heartburn may result from abnormal motor activity or distention of the esophagus reflux of acid or bile into the esophagus, or direct esophageal mucosa irritation (esophagitis). Heartburn is most often associated with gastroesophageal reflux. In this setting, heartburn typically occurs after a meal, with stooping or bending, or when the patient is supine. It may be accompanied by the spontaneous appearance in the mouth of fluid which may be salty, sour, or bitter and green or yellow. Heartburn may arise following the ingestion of certain foods (e.g. citrus fruit juices) or drugs (e.g. alcohol or aspirin). Reflux esophagitis consists of esophageal mucosal damage resulting from reflux of gastric or intestinal contents into the esophagus. Esophagitis, an inflammation of the esophagus from regurgitation of acid gastric contents, producing substernal pain, develops when the mucosal defenses that normally counteract the effect of injurious agents on the esophageal mucosa succumb to the onslaught of the refluxed acid pepsin or bile. Mild esophagitis shows microscopic changes of mucosal infiltration with granulocytes or eosinophils, hyperplasia of basal cells, and elongation of dermal pegs. Erosive esophagitis shows endoscopically visible damage to the mucosa in the form of marked redness, friability, bleeding, superficial linear ulcers, and exudates. Web site: http://www.delphion.com/details?pn=US05854267__ •

Method for testing for gastroesophageal reflux disease Inventor(s): Orr; William C. (5300 N. Independence Ave., Suite 130, Oklahoma City, OK 73112) Assignee(s): none reported Patent Number: 5,951,468 Date filed: August 20, 1997 Abstract: An easy, safe and inexpensive procedure to testing the presence of esophageal acid sensitivity in a patient involves having the patient swallow a controlled quantity of a weak acid solution and a similar-tasting controlled quantity of a neutral solution and recording the reactions or symptoms experienced by the patient during the drinking of each solution. The acid solution only should affect the sensitivity of the esophageal lining in patients with esophageal acid sensitivity, providing heartburn and other related symptoms to include non-cardiac chest pain, but should not have any significant effect on patients without esophageal acid sensitivity. The neutral solution may be altered to simulate the taste of the acid solution and reduce the effect the taste of the solutions may have on the test results. Excerpt(s): This invention relates to medical diagnostic testing, and more particularly to a medical test that determines the likelihood that chest pain symptoms can be attributed to the reflux of acidic gastric contents. Gastroesophageal reflux is a common human condition arising from the backwash or "reflux" of stomach acid into the esophagus. Mild reflux with "heartburn" is a very common condition experienced by nearly everyone at one time or another. However, prolonged or repeated bathing of the esophagus with gastric acid may lead to gastroesophageal reflux disease or "GERD." GERD is a disease that produces symptoms and/or tissue damage secondary to the reflux of gastric contents into the esophagus. A primary symptom of GERD is

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heartburn. The prevalence of GERD in the U.S. population is increasing and, at a minimum, effects approximately ten percent (10%) of the U.S. population. This segment of the population has heartburn daily. More than one-third of the U.S. population, however, is estimated to have intermittent heartburn symptoms. Left untreated, GERD may lead to esophagitis, an esophageal ulceration, stricture or a malignant tumor formation. Web site: http://www.delphion.com/details?pn=US05951468__ •

Method of stimulating gastrointestinal motility with ellagic acid Inventor(s): Khambe; Deepa Ashok (Bombay, IN), Rajagopalan; Tuticorin Govindachari (Bombay, IN) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,843,987 Date filed: October 31, 1997 Abstract: The present invention relates to the use of ellagic acid for the treatment of gastrointestinal disorders by stimulating the motility of the GI tract. In particular the present invention relates to a method of treatment of constipation, heartburn, non ulcer dyspepsia, GERD, and/or esophagitis, with a pharmaceutical composition comprising a safe and effective amount of ellagic acid or pharmaceutically acceptable salts or esters thereof. Preferably the ellagic acid is administered perorally. Excerpt(s): The present invention relates to the use of ellagic acid and pharmaceutically acceptable salts or esters thereof for the treatment or prevention of gastrointestinal disorders requiring stimulation of the motility of the gastrointestinal (GI) tract, e.g. for enhancing esophageal contractility, for stimulating gastric emptying, and for stimulating small intestinal transit time. In particular the present invention relates to a method of treatment or prevention of constipation, heartburn, NUD (non ulcer dyspepsia), GERD (gastroesophageal reflux disease), esophagitis, gastric ulcers, and/or duodenal ulcers, in a human or other animal, with a safe and effective amount of ellagic acid and pharmaceutically acceptable salts or esters thereof. This application claims priority under Title 35, United States Code 119(e) from Provisional Application Ser. No. 60/030,421, filed Oct. 31, 1996. Ellagic acid, is also known as 2,3,7,8Tetrahydroxy›1!benzopyrano-›5,4,3-cde!›1!benzopyran-5,10-dione; 4,4', 5,5', 6,6'-hexahydrodiphenic acid 2,6,2', 6'-dilactone, benzoaric acid, Lagistase, hexahydroxydiphenic acid-dilactone, and olyphenolic acid. The chemical formula is C.sub.14 H.sub.6 O.sub.8. Ellagic acid is a naturally occurring plant phenol, occurring in its free form or in the form of ellagitannins or glucosides. It is found in certain fruits, nuts and vegetables, such as grapes, strawberries, blackberries, raspberries, cranberries, walnuts, guavas, mangoes, green tea, and pecans. It is also found in dicotyledonous plants in the genera of castenea, eucalyptus, eugenia, euphorbia, gerinimum, mangifera, platycarya, quercus, rhus and terminalia. Dhingra et al., Determination of free ellagic acid by reversed-phase high-performance liquid chromatography. Journal of Chromatography, 447 (1988) 284286. Ellagic acid is present in plants as ellagitannins, which consist of a central core of glucose esterified with hexahydroxydiphenic acid. These precursor molecules may undergo hydrolysis with acid or base to yield ellagic acid. Physico-chemical properties of ellagic acid are described in: Press, Hardcastle, J. Appl. Chem. 19, 247 (1969). Web site: http://www.delphion.com/details?pn=US05843987__

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Method of treatment of gastroesophageal reflux disease by enhancement of salivary esophageal protection due to mastication Inventor(s): McCallum; Richard (Charlottesville, VA), Sarosiek; Jerzy (Charlottesville, VA) Assignee(s): The University of Virginia Patents Foundation (Charlottesville, VA) Patent Number: 5,730,958 Date filed: August 16, 1996 Abstract: Prolonged mastication is demonstrated to enhance salivary secretion as well as enhance secretion of salivary components such as salivary bicarbonate, epidermal growth factor, mucin, PGE.sub.2 and transforming growth factor.sub.alpha. Mastication beginning prior to about 30 minutes in advance of any meal may reduce sensations of heartburn in patients and has therapeutic value in the treatment of patients with reflux esophagitis and gastroesophageal reflux disease. Post-meal chewing is of additional value in alleviating severe symptoms. Excerpt(s): This application claims priority of U.S. Provisional application Ser. 60/002,511, filed Aug. 18, 1995. This invention pertains to a method of treating gastroesophageal reflux disease (GERD) by encouraging patients suffering from the same to chew, or masticate. Mastication, both pre- and post-meal chewing, improves esophageal protection, useful in treating and controlling GERD. Those who suffer from endoscopic RE may also benefit from such mastication, as an augment to other available therapies. The item chewed may be any non-toxic chewable item that will support an extended period (at least about 30 minutes) of chewing, including conventional chewing gums, inert plastic films, leather and the like. The protective role of salivary inorganic and organic components in the maintenance of the esophageal mucosal integrity both in the experimental and clinical settings is a rapidly evolving research arena. It has been demonstrated experimentally that surgical removal of salivary glands in rats resulted in 108% increase in the rate of permeability of the esophageal mucosa to hydrogen ion accompanied by an 83% decline in the content of mucus within the pre-epithelial mucosal barrier. Sarosiek et al., Am. J. Med. Sci. 302:359-363 (1991). Clinical studies have revealed that salivary buffering capacity is pivotal in restoration of pH within the preepithelial barrier as assessed by 24 hour pH monitoring. Helm et al., Gastroenterology 83:69-74(1982). In addition, a plethora of salivary organic components such as epidermal growth factor (EGF), mucin, PGE.sub.2 and transforming growth factor.sub.alpha. (TGF.sub.alpha.) well known for their protective potential within the oral cavity and gastric mucosa, are shown to have a significant impact on the integrity of the esophageal mucosal barrier. Therefore, a quantitative and qualitative enhancement of salivary secretion that could benefit protective mechanisms operating within the esophageal preepithelial barrier, crucial in the combat of gastroesophageal reflux (GER) is an object of these of skill in the art. Web site: http://www.delphion.com/details?pn=US05730958__

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Methods and pharmaceutical compositions for treating episodic heartburn Inventor(s): Wolfe; M. Michael (Newton, MA) Assignee(s): Brigham and Women's Hospital, Inc. (Boston, MA) Patent Number: 5,229,137 Date filed: May 6, 1992

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Abstract: Pharmaceutical medications and methods are disclosed for providing instant and sustained relief from pain or symptoms associated with episodic heartburn in humans. The medications consist essentially of antacids and histamine H.sub.2 -receptor antagonists, and may be administered on an as-needed basis in liquid or solid dosage forms. Typical antacids which may be used in combination with the histamine H.sub.2 receptor antagonist are conventional antacids which are well known and widely used in the treatment of excess acid related gastrointestinal dysfunctions. Exemplary of typical antacids include, sodium bicarbonate, calcium carbonate, magnesium hydroxide and aluminum hydroxide, as well as commercially available high potency, flavored antacids. Histamine H.sub.2 -receptor antagonists which may be used in combination include those conventionally used in the treatment of peptic ulcers, such as, for example, cimetidine, ranitidine, famotidine and nizatidine. In carrying out the methods, an antacid and histamine H.sub.2 -receptor antagonist may be administered together as a single unitary dose in the form of a liquid or solid, or administered together, but separately as either liquids or solids or a combination thereof. The oral medications when formulated as a single unitary dose may include other additives, such as, for example, antiflatulents, flavorings, sweeteners and the like. Excerpt(s): The present invention relates to pharmaceutical compositions and methods for providing immediate and sustained relief from pain, discomfort and/or symptoms associated with episodic heartburn in humans. About 7-10 percent of all people suffer daily, and about 25-40 percent monthly, from pain, discomfort and/or symptoms associated with episodic heartburn. Episodic heartburn is defined as the sensation of burning under the sternum (breastbone) and is usually associated with the ingestion of different foods. Episodic heartburn has also been referred to as "sour stomach," "indigestion," and "waterbrash/regurgitation." Although different foods, such as coffee, mints, fatty foods, alcohol, and chocolate, are usually implicated in the etiology of episodic heartburn, these symptoms can be caused by any type of food in certain people. Moreover, in many people, there is no inciting agent that can be identified, rather the disorder occurs without any known provocation. At present, the primary treatment is based upon the neutralization of gastric acid and pepsin with antacids, such as, for example, aluminum hydroxides, calcium carbonates, magnesium hydroxides and sodium bicarbonates. Of less importance, treatment is based upon the inhibition of secretion by histamine H.sub.2 -receptor antagonists, such as cimetidine and ranitidine. Web site: http://www.delphion.com/details?pn=US05229137__ •

Oral pharmaceutical dosage forms comprising a proton pump inhibitor and an antacid agent or alginate Inventor(s): Depui; Helene (Goteborg, SE), Hallgren; Agneta (Molndal, SE) Assignee(s): Astra Aktiebolag (Sodertalje, SE) Patent Number: 6,183,776 Date filed: February 13, 1997 Abstract: An oral pharmaceutical dosage form comprising an acid susceptible proton pump inhibitor and one or more antacid agents or an alginate in a fixed formulation, wherein the proton pump inhibitor is protected by an enteric coating layer and an optional separating layer in between the proton pump inhibitor and the enteric coating. The fixed formulation is in the form of multilayered tablets, sachets or multiple unit tableted dosage forms. The multiple unit dosage form is most preferred. The new fixed

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formulation is especially useful in the treatment of disorders associated with dyspepsia such as heartburn. Excerpt(s): The present invention is related to new oral pharmaceutical preparations especially for use in the prevention and treatment of dyspeptic symptoms like upper abdominal pain/discomfort and heartburn. The present preparations comprise a combination of different gastric acid suppressing agents, such as an acid susceptible proton pump inhibitor and antacid agent(s) and/or an alginate in a new fixed unit dosage form, especially a tableted dosage form. Furthermore, the present invention refers to a method for the manufacture of such preparations and the use of such preparations in medicine, especially in the treatment of dyspeptic symtoms. Dyspepsia is a common disorders and patients are seeing both gastroenterologists and general practicians because of it. Heartburn is a symptom of dyspepsia, and it is estimated that 44% of Americans have heartburn at least monthly and some has to contact a doctor about the problem, but only around 25% of the patients are seeing the doctor because of their dyspepsia problem. Symtoms associated with dyspepsia symtom are for instance upper abdominal pain/discomform and heartburn, indigestion, sour stomach, heartburn and other gastrointestinal disorders including gastro oesophageal reflux. The wide diversity of symptoms and disease severity produced by gastro oesophageal reflux has led to the need for more individualized treatment strategies. Therapeutic agents effective in the treatment of dyspepsia include gastric acid suppressing agents, such as H.sub.2 receptor antagonists, proton pump inhibitors, other agents of interest are antacids/alginates and prokinetic agents. These agents can be distinguished by their mechanisms of action, safety profile, pharmacokinetics and indications. WO 95/017080 describes a composition for use in the treatment of for instance heartburn, the composition comprises a H.sub.2 receptor antagonist, such as famotidine, and an alginate and optionally simethicone. Web site: http://www.delphion.com/details?pn=US06183776__ •

Portable bed raiser Inventor(s): Houchin; Harold E. (581 Teryl Rd., Apartment #5, Naples, FL 33962) Assignee(s): none reported Patent Number: 5,713,091 Date filed: November 15, 1995 Abstract: An adjustable and portable bed raiser which raises the head of a bed to an incline so as to reduce gastroesophageal reflux, and thus heartburn, while a user is sleeping. The adjustable bed raiser is separate from the bed intended to be lifted and is comprised of a rotary motor, a mattress support, a control means electrically connected to the motor, a means for lifting the mattress support, and thus the bed to an inclined position. Excerpt(s): The present invention relates generally to an apparatus for adjusting the position of a bed, more particularly, to a portable and economical apparatus for raising the bed to an incline position. Gastroesophageal Reflux Disease (GERD) refers to symptoms or tissue damage that result from gastroesophagea/reflux. Reflux generally refers to the repulsion of the stomach contents, most often acids, into the esophagus. The tissue of the esophagus is damaged as it is very sensitive to the reflux as the esophagus does not contain the special lining of the stomach which protects against the harmful gastric acids. Heartburn is the most common and specific symptom of GERD. In some

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patients, chest pain or respiratory symptoms may be the only presenting signs. Gastroesophageal Reflux Disease (GERD) is a common problem in the general population. Studies have shown that there is a prevalence of GERD in the elderly. As discussed, GERD often results from an increased frequency or duration of exposure of the distal esophagus to gastric contents. Impaired esophageal clearance leads to this prolonged exposure to refluxate acid. Malfunctioning of the Lower Esophageal Sphincter(LES), a "valve" which keeps the gastric contents from entering into the esophagus, is a common cause of reflux, and most often to GERD. Web site: http://www.delphion.com/details?pn=US05713091__ •

Thieno[3,2-b]pyridine derivatives Inventor(s): Maruyama; Akira (Kashima, JP), Ogawa; Shigeru (Machida, JP), Tobe; Akihiro (Yokohama, JP), Yamazaki; Satoshi (Sagamihara, JP) Assignee(s): Mitsubishi Kasei Corporation (Tokyo, JP) Patent Number: 5,352,685 Date filed: March 11, 1993 Abstract: The thieno[3.2-b]pyridine derivative of the present invention promote the gastric emptying in male ddy mice and the gastric contraction in dogs sutured with a strain-gauge transducer. It is believed that the derivatives have the action to enhance gastric motor action and gastric emptying. Therefore, the compound of the present invention are effective for the prevention and therapeutical treatment of the symptoms caused by gastric hypanakinesis, such as heartburn, abdominal distension feeling, anorexia, unpleasant feeling on upper abdomen, abdominalgia, nausea, vomiting, etc. caused by the underlying diseases such as acute and chronic gastritis, stomach and duodenum ulcer, gastroneurosis, gastroptosis, etc. The present invention also encompasses a pharmaceutical composition containing as the effective ingredient a compound of the present invention, and a method for producing the same. Excerpt(s): The present invention relates to novel thieno[3,2-b]pyridine derivative useful as pharmaceutical agents. More specifically, the present invention relates to novel thieno[3,2-b]pyridine derivatives, the pharmaceutically acceptable salts thereof and the solvates thereof, effective for the prevention and therapeutical treatment of the symptoms due to gastric hypanakinesis, such as heartburn, abdominal distension feeling, anorexia, unpleasant feeling on upper abdomen, abdominalgia, nausea, vomiting, etc. caused by the underlying diseases such as acute and chronic gastritis, stomach and duodenum ulcer, gastroneurosis, gastroptosis, etc. So-called complaint of general malaise of gastrointestinal tract, such as heartburn, abdominal distension feeling, anorexia, unpleasant feeling on upper abdomen, nausea, vomiting, abdominalgia, etc., develop as the symptoms of diseases such as acute and chronic gastritis, stomach and duodenum ulcer, gastroneurosis, gastroptosis, etc., and the major underlying cause is the decrease in gastric emptying potency via the gastric hypanakinesis. So as to improve gastric hypanakinesis, use has conventionally been made of 4-amino-5-chloro-N-[(2-diethylamino)ethyl]-2-methoxybenzamide [generic name; metoclopramide: see Merck Index, 11 ed., 6063(1989)], but it has been known that the agent has side effects including damage to the on extrapyramidal system or side effects on central nervous system. Web site: http://www.delphion.com/details?pn=US05352685__

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Patent Applications on Heartburn As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to heartburn: •

Controlled food flow in a patient Inventor(s): Forsell, Peter; (Menzingen, CH) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 North Glebe Road; Arlington; VA; 22201-4714; US Patent Application Number: 20010011543 Date filed: January 4, 2001 Abstract: In the treatment of morbid obesity or heartburn and reflux disease an elongated restriction member (12) is formed in a substantially closed loop around a human's stomach or esophagus to form a stoma opening in the stomach or esophagus. The size of the stoma opening is adjustable by an implanted adjustment device. A control device (22) is utilized to control the adjustment device, in order to either reduce or enlarge the size of the stoma opening, for example in response to the time of the day. Nausea in a treated obese human can be minimized or substantially eliminated as a result of the control device controlling the adjustment device to keep the stoma opening substantially fully open between meals (such as at night when the human is sleeping).A sensor (23), such as a pressure or position sensor, is surgically implanted in the human's body so that the sensor may either directly or indirectly sense a physical parameter of the human, such as the pressure in the stomach or the human's orientation with respect to the horizontal. If in response to sensing by the sensor it is determined by the control device that a significant change in the physical parameter has occurred, then the control device controls the adjustment device to either reduce or enlarge the size of the stoma opening. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 09/373,224, filed Aug. 12, 1999. The present invention relates to an apparatus and procedure for controlling the food flow through the stomach or esophagus of a patient. This kind of apparatus in the form of a gastric banding device, in which a band encircles a portion of a patient's stomach to restrict the food intake of the patient, have been used in surgery for morbid obesity to form a small gastric pouch above the band and a reduced stoma opening in the stomach. Although such a band is applied around the stomach to obtain an optimal stoma opening during surgery, some prior gastric banding devices are provided with an adjustment means enabling a minor post-operation adjustment of the size of the stoma opening. In all such prior art devices, such as disclosed in U.S. Pat. No. 4,592,339, European Patent No. 0611561 and International Patent Application WO 94/27504, the adjustment means typically comprises an inflatable cavity in the band and an injection port in fluid connection with the inflatable cavity. The injection port is subcutaneously implanted to allow the addition of fluid to or withdrawal of fluid from the cavity by an injection needle penetrating the patient's skin and passing into the injection port. In practice, the band is made of silicone which is a material approved for implantation and the fluid is a liquid such as an isotonic salt solution mixed with other conventional materials.

9

This has been a common practice outside the United States prior to December 2000.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

GASTRIC EMPTYING-PROMOTING COMPOSITION Inventor(s): KONDO, TAKAHARU; (GIFU, JP) Correspondence: Sughrue Mion Zinn Macpeak & Seas; 2100 Pennsylvania Avenue N W; Washington; DC; 20037 Patent Application Number: 20020018773 Date filed: December 21, 1998 Abstract: Compositions having an effect of promoting gastric emptying. These compositions comprise a lipase which was found to have an effect of promoting gastric emptying together with lipase activity-free ingredient(s) acting on the digestive tracts such as a prokinetic, a histamine H.sub.2 receptor antagonist, a proton pump inhibitor and/or a stomachic ingredient. They are efficaciously employed as medicaments for ameliorating or treating chronic gastrointestinal symptoms such as sinking feelings, heartburn and heaviness in the stomach, i.e., complaints about the digestive tracts. Excerpt(s): This invention relates to compositions having an effect of promoting the gastric emptying. More particularly, it relates to medicaments containing a lipase preparation which is a digestive enzyme. The medicaments of the present invention are efficaciously used in ameliorating or treating chronic gastrointestinal symptoms such as sinking feelings, heartburn and heaviness in the stomach, i.e., complaints about the digestive tracts. Even healthy people often notice subjective gastric symptoms (sinking feelings, heartburn, anorexia, etc.) in the everyday life. These symptoms are caused by stress, overeating, excessive intake of alcoholic drinks and intake of drugs. Moreover, it is frequently observed that the stress of the complicated current social structure or side effects of medicaments result in chronic gastrointestinal symptoms such as sinking feelings and heaviness in the stomach, i.e., complaints about the digestive tracts, which is now a serious social problem. In the present aging society, furthermore, the aged are largely affected by the above-mentioned problem. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Heartburn and reflux disease treatment apparatus Inventor(s): Forsell, Peter; (Menzingen, CH) Correspondence: Nixon & Vanderhye P.C.; 1100 North Glebe Road, 8th Floor; Arlington; VA; 22201; US Patent Application Number: 20020193842 Date filed: June 29, 2001 Abstract: A heartburn and reflux disease treatment apparatus comprises an electric stimulation device (56) adapted to engage the cardia sphincter (58) of a patient, who suffers from heartburn and reflux disease, and electrically stimulate the cardia sphincter to increase the sphincter tonus, so that the cardia completely closes. A control device (62) is provided for controlling a source of energy (64), which may or may not be implanted, to release electric energy for use in connection with the power of the stimulation device.

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Excerpt(s): Heartburn and reflux disease is a widespread medical problem. This is often due to hiatal hernia, i.e. a portion of the stomach immediately below the gastric fundus slides upwardly through the esophageal hiatus. In consequence, stomach acids and foods are regurgitated into the esophagus. In the late 1970s a prior art restriction device called Angelchik, according to U.S. Pat. No. 3,875,928, was used to operatively treat heartburn and reflux disease. However, the Angelchik restriction device had a major disadvantage in that it was not possible to adjust the size of the restriction opening after the operation. A further disadvantage was that the restriction device did not satisfactorily protect the esophagus and the surrounding area against injuries due to poor shape of the restriction device. Therefore, operations using the Angelchik stimulation device are no longer practised. An operation technique, semifundoduplicatio, is currently in use for treating heartburn and reflux disease. A most common operation is Nissen semi-fundoduplicatio, in which one takes the fundus of the stomach and makes a three-quarter of a turn around the esophagus and suture between the stomach and esophagus. Although this operation works fairly well it has three main disadvantages. Firstly, most patients' treated in accordance to "ad modum Nissen" lose their ability to belch. Secondly, many of these patients's get dysphagia, i.e. difficulties to swallow after the operation. Thirdly, it is not possible to adjust the food passageway in the esophagus or stomach in any way after the operation. Characteristic for these patients's is the variation of their problems over the day. For example, many patients have difficulties during the night when they lie down because of stomach acid leaking up into the esophagus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Honey-based composition for relief of occasional heartburn and digestive disorders Inventor(s): Postmes, Theo; (Maashicha, NL) Correspondence: Womble Carlyle Sandridge & Rice; P.O. Box 725388; Atlanta; GA; 31139-9388; US Patent Application Number: 20010006687 Date filed: December 20, 2000 Abstract: According to the present invention, a composition is provided including honey and raw food fibers. The composition's primary use is to relieve occasional heartburn and digestive disorders including GERD and stomach and intestine complaints. Further, the composition of the present invention may be processed into a compressed product. Among the many advantages of the composition of the present invention are that the composition normalizes the defective physiology of the digestion; the composition achieves the desired therapeutic effect quickly; and the composition is provided as a natural product without adverse side effects found with typical pharmaceutical products. Excerpt(s): This application claims foreign priority benefits under 35 U.S.C.sctn.119,.sctn.365 and/or.sctn.371 of the earlier filed Netherlands Patent Application No. 1013943, filed Dec. 23, 1999. The present invention generally relates to a composition, preferably a natural composition, for the relief of occasional heartburn and digestive disorders including gastroesophageal reflux disease (GERD) and stomach and intestine complaints. Indigestion, as well as heartburn, occurs frequently. Stomach pain and severe heartburn are, if they only occur from time to time, a normal deviance of the digestion physiology. Overweight, over eating, over consumption of alcohol, worry and stress are correlating factors to the appearance of disturbances in the digestion

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(dyspepsia). The over-production of acid is a characteristic of this disturbance, which can be remedied by reducing the production of acid or by neutralizing the stomach acid with antacids (e.g., with calcium carbonate and magnesium carbonate such as RENNIES). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel arginine/ascorbic acid mixed powder as an oral supplement Inventor(s): Kimoto, Eiji; (Jonan-ku, JP), Morishige, Fukumi; (Sanbu-gun, JP) Correspondence: Oliff & Berridge, Plc; P.O. Box 19928; Alexandria; VA; 22320; US Patent Application Number: 20020091156 Date filed: November 13, 2001 Abstract: A mixture obtained by mixing ascorbic acid powder with arginine powder in a weight ratio (ascorbic acid/arginine) of 1/5 to 20, especially 1/5 to 1/4; and a supplement such as a nutrient preparation and a health-care food containing the mixture. Mixing of arginine powder and ascorbic acid powder in the weight ratios eliminates stringent taste specific to arginine and alleviates stringent feeling in the stomach (heartburn, nausea or vomiting) after oral intake thereof. The mixture prevents also peroxidative injuries of cells caused by an administration of a great amount of arginine alone. Further, mixing of arginine powder with ascorbic acid powder prevents browning of the mixture after long-term storage. Excerpt(s): The present invention relates to a method for eliminating the stringent taste and alleviating stringent feeling in the stomach of L-arginine (hereinafter referred to as arginine) by mixing L-ascorbic acid (hereinafter referred to as ascorbic acid) and for alleviating the toxicity of arginine-derived NO radical by arginine-ascorbic acidcombined treatment. From late 1970's to 1980's, a research group of Illinois University reevaluated that dietary arginine is indispensable for optimal health of adult and especially aged humans. (see E. Kimoto, "Nutritional Chemistry of L-Arginine", Kaisei Publishing Co. Ltd., Tokyo, 1999 (Literature 2), page 93). In 1987, it was reported that NO radical participating in a wide variety of physiological functions such as blood pressure control and prevention of infections is derived from arginine as a source. This led to increased attention paid to arginine in the field of amino acid nutrition science (see Literature 2, page 57). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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PROKINETIC AGENTS FOR TREATING GASTRIC HYPOMOTILITY AND RELATED DISORDERS Inventor(s): ANDREWS, PAUL L. R.; (LONDON, GB), WATSON, JOHN W.; (LEDYARD, CT), WOODS, ANTHONY J.; (LONDON, GB) Correspondence: Pfizer Inc; 150 East 42nd Street; 5th Floor - Stop 49; New York; NY; 10017-5612; US Patent Application Number: 20030176421 Date filed: December 30, 1999 Abstract: Stasis is treated or prevented in all or any part or parts of the stomach of a patient, especially a human patient, in need of such treatment, where said stasis results

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from hypomotility in the stomach, particularly gastric hypomotility with delayed emptying of the liquid and/or solid contents of the stomach. Gastric or gastrointestinal disorders are also treated which are characterized by one or more symptoms selected from pain, nausea, vomiting, heartburn, postprandial discomfort, indigestion and gastroesophageal reflux. Such treatment or prevention is achieved by administering to the patient a therapeutically effective amount of an inhibitor of phosphodiesterase-4 (PDE4), including isozyme subtypes thereof, sufficient to treat or prevent such hypomotility or gastric or gastrointestinal disorder in said patient. The PDE4 inhibitor comprises a compound of Formula (IA) or (IB): 1where in a preferred embodiment, R is cyclopentyl or cyclohexyl; R.sup.1 is (C.sub.1-C.sub.2) alkyl; one of R.sup.2.sub.a and R.sup.2.sub.b is hydrogen and the other is a substituent of partial Formula (1.0.0) above, where the dashed line represents a single bond, m is 0, R.sup.113 and R.sup.114 are in a cis relationship to each other, R.sup.113 is cyano, R.sup.115 is hydrogen, and R.sup.114 is carboxy, --CH.sub.2OH, or --CH.sub.2C(.dbd.O)NH.sub.2.Pharmaceutical compositions are also described which are useful for carrying out the above-mentioned methods of treatment and prevention, and which are also useful in the treatment of a gastric or gastrointestinal disorder in a patient which comprises with respect to said patient, (i) a sign or concomitant of diabetic neuropathy, anorexia nervosa, achlorhydria, gastrointestinal surgery, post-surgical recovery in the period of emergence from general anesthesia; or the administration of morphine and morphine-like opioids; (ii) a secondary aspect of a primary disease or disorder in said patient which is organic, wherein said disease or disorder involves particularly a gastroenteric or gastroesophageal organ or tissue, or an organ or tissue of the central nervous system of said patient; or (iii) an adverse side effect of a different therapeutic agent administered to said patient in the course of treating another unrelated disease or disorder in said patient. Excerpt(s): The method of treatment of the present invention involves a therapeutic agent having a prokinetic effect on, i.e., that promotes activity with regard to gastric motility. This type of drug is useful in treating gastric hypomotility with delayed gastric emptying of liquid and/or solid contents of the antrum (stomach), which is a component of a number of gastric or gastrointestinal disorders. The symptoms of such gastric or gastrointestinal disorders can be quite serious and include pain, nausea, vomiting, heartburn, postprandial discomfort, indigestion, and gastroesophageal reflux. In particular, the present invention relates to therapeutic agents which by various mechanisms are able to elevate cAMP in populations of neurons in the myenteric plexus, leading to release of excitatory transmitters, e.g., acetylcholine, and subsequent stimulation with resulting contraction of the smooth muscle of the antrum. The therapeutic compounds useful as active ingredients in the pharmaceutical compositions and methods of treatment of the present invention are closely related, in terms of their chemical structure and biological activity, to inhibitors of the phosphodiesterase-IV (PDE4) isoenzyme. However, to date the art has incorrectly taught that PDE4 inhibitors antagonize gastrointestinal contractile responses, suggesting their use as antikinetic agents for treating hypermotility disorders; rather than as prokinetic agents for treating gastric hypomotility, as surprisingly discovered in accordance with the present invention. The gastrointestinal system must preserve a proper balance between absorption and secretion of water and electrolytes in order to keep nutrients, wastes, electrolytes and water in a life-sustaining flux. Equally important to successful performance of this ongoing process is the maintenance along the gastrointestinal tract of the appropriate anterograde motility. Gastrointestinal motility is also known to be a key component of vomiting. This aspect of its role is important in light of the fact that

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some antiemetic agents have enhanced gastric emptying as a significant aspect of their actions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Reduction of heartburn episodes after ingestion of orange juice Inventor(s): Green, Nancy R.; (Bradenton, FL), Letourneau, Stephen A.; (Holmes Beach, FL), McArdle, Richard N.; (Bradenton, FL), McGill, Carla R.; (Sarasota, FL) Correspondence: Cook, Alex, Mcfarron, Manzo, Cummings & Mehler Ltd; Suite 2850; 200 West Adams Street; Chicago; IL; 60606; US Patent Application Number: 20020192309 Date filed: May 3, 2001 Abstract: Reducing heartburn episodes is achieved in individuals having an orange juice intolerance or food allergy. The orange juice product has a low titratable acidity which combines with a condition resulting after addition of a calcium source such as a calcium citrate source. Individuals prone to orange juice induced heartburn episodes experience a reduced incidence of these heartburn episodes. Excerpt(s): This invention relates to approaches for reducing heartburn episodes when an individual having an orange juice intolerance ingests orange juice according to the invention. The invention is achieved without any substantial negative impact on orange juice flavor or other important attributes. The heartburn reduction is achieved by orange juice which combines the features of being of a lower acid type while incorporating a calcium source such as in the form of a calcium citrate source. Numerous individuals have been known to experience negative effects upon ingesting different foods. A true food allergy occurs when the immune system of the individual overreacts to certain proteins in food. It is believed that hundreds of food ingredients can provoke an allergic reaction. Typical foods in this regard are nuts, peanuts, milk, eggs, fish, shellfish, soybeans and wheat. Foods such as these can lead to symptoms including nausea, hives, skin rash, nasal congestion, wheezing, and the like. However, most unpleasant reactions to food are caused not by allergies but by intolerances, which tend to be less severe than true food allergies. Typical in this regard are lactose intolerance, sulfite intolerance and intolerance to monosodium glutamate, red wine, chocolate and food coloring agents. Another intolerance of some frequency is manifested by gastral distress and/or digestive difficulties which certain individuals experience shortly after ingesting orange juice products. In some circles, it is generally assumed that the relatively high acidity of orange juice products is a primary contributor to these negative or unpleasant experiences with orange juice products for a small percentage of the population. For example, Kligerman et al U.S. Pat. No. 5,665,415 and No. 5,869,119, incorporated hereinto by reference, suggest that acidic foods or beverages such as coffee and other beverages can be combined with calcium glycerophosphate so as to raise the pH of the food or beverage by at least 0.5 pH units, such as to a pH of greater than 5.4, which typically is pH higher than desirable for superior tasting orange juice. This pH adjustment is said to reduce the tendency of the food or beverage to cause heartburn and other esophageal and/or gastrointestinal distress. This approach generally follows the conventional wisdom that ingesting antacids treats heartburn by helping to neutralize stomach acid. This approach suggests, in general, raising the pH of the food or beverage to well above 5. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with heartburn, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “heartburn” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on heartburn. You can also use this procedure to view pending patent applications concerning heartburn. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON HEARTBURN Overview This chapter provides bibliographic book references relating to heartburn. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on heartburn include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “heartburn” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on heartburn: •

Heartburn and What to Do About It Source: Garden City Park, NY: Avery Publishing Group. 1998. 182 p. Contact: Available from Avery Publishing Group. 120 Old Broadway, Garden City Park, NY 11040. (800) 548-5757 or (516) 741-2155. Fax (516) 742-1892. E-mail: [email protected]. PRICE: $10.95 plus shipping and handling. ISBN 0895297922. Summary: In this book, the authors tell readers how to banish heartburn and other digestive symptoms once and for all, using natural therapies that are gentle on one's system. The authors emphasize that a lack of balance in the digestive tract, caused by improper diet and the stresses of modern life, is at the root of most people's intestinal upsets, and they explain both the problem and the solution in clear, nontechnical language. In Part One, after surveying the scope of the nation's digestive difficulties, the authors review the most common digestion related disorders. They discuss ulcers and

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the infection (Helicobacter pylori) that causes ulcers. The authors then look at disorders that can cause both common digestive symptoms, such as diarrhea, constipation, nausea, and gas, and symptoms that most readers may not associate with the digestive system, such as fatigue and skin rashes. In Part Two, the authors explain how to relieve and prevent digestive troubles through the use of proper diet, yogurt, and intestinal cleansers. Finally, the authors offer a detailed discussion of probiotics, the friendly bacteria that not only help protect the digestive tract from bad bacteria and assist in digestion itself, but also improve overall health. The authors conclude that restoring intestinal health first requires a change in diet, with a reduction in or elimination of highly processed, sugary, and fatty foods, and a corresponding increase in whole grains, fresh fruits and vegetables, limited amounts of organically raised meat, and cultured foods such as yogurt. These changes in diet must be supported by adequate exercise, rest, and stress reduction. The book concludes with a resource list, a suggested reading list, a list noting sources of products and services, endnotes, and a subject index. 250 references. •

Ulcer Story: The Authoritative Guide to Ulcers, Dyspepsia, and Heartburn Source: New York, NY: Plenum Publishing. 1996. 415 p. Contact: Available from Plenum Publishing. 233 Spring Street, New York, NY 110131578. (800) 221-9369 or (212) 620-8000. PRICE: $29.95. ISBN: 0306452758. Summary: This book brings the general reader up to date on the causes and treatments of ulcers, dyspepsia, and heartburn. The book is divided into seven parts. The first begins with a review of upper gut anatomy; chapters on physiology and terminology are designed to assist those with a nonmedical background. Technical terms and short forms are redefined at the beginnings of relevant chapters. Next is a brief history of peptic ulcer and gastroesophageal reflux. Part One ends with a discussion of the epidemiology of ulcers, dyspepsia, and heartburn. Part Two discusses the causes of peptic ulcer. The anti-arthritis NSAIDs and infection of the gastric mucosa with Helicobacter pylori are the principal causes of peptic ulcers. Part Three discusses dyspepsia, the cardinal symptom of ulcers. A brief description of gastric and duodenal ulcers, a review of rare and atypical ulcers, and a discussion of ulcer complications follow the discussion of dyspepsia. Part Four focuses on gastroesophageal reflux (GER), the mechanism underlying heartburn and esophagitis. The author notes that heartburn is often confused with dyspepsia, both ulcers and esophagitis depend upon gastric acid, and both diseases are healed with anti-ulcer drugs. Part Five addresses related subjects, including non-ulcer dyspepsia, abdominal bloating, noncardiac chest pain, and gastric and esophageal cancers. In Part Six, the author reviews the drugs prescribed and operations performed for peptic ulcers or gastroesophageal reflux disease. Part Seven focuses on diagnostic tests and research activities that support the treatment options for ulcer, heartburn, dyspepsia, and other symptoms. The author offers a British perspective on health care. A subject index concludes the volume. 397 references. (AA-M).

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Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones Source: New York, NY: Oxford University Press. 1992. 227 p. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. PRICE: $11.95 plus shipping and handling. ISBN: 019508554X.

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Summary: This book offers advice on how to take care of and avoid a whole complex of disturbances categorized as indigestion. The author begins with an overview of the anatomy and physiology of digestion, including a chapter on terminology and definitions. After an additional chapter on diagnostic testing, the author turns to specific problems, including acid related problems (heartburn, esophagitis, and hiatal hernia), peptic ulcers, nonulcer dyspepsia, chest pain, gallbladder problems and gallstones, pancreatic diseases, jaundice, malabsorption and maldigestion, food intolerance and food allergies, the impact of aging on the upper digestive tract (including the role of medications and drug interactions), and the brain gut connection. The appendices of the book offer coverage of related problems, including belching, nausea and vomiting, dry mouth and bitter taste, difficulty in tasting, lump in the throat, butterflies, difficulties in swallowing, delayed stomach emptying, the effects of diabetes on the upper digestive system, and the controversy over yeast. The author hopes to foster a cooperative dialogue between patients and their physicians as they work together to diagnose and manage upper digestive tract problems. A subject index concludes the book. 8 figures. 6 tables. •

Fire Inside: Extinguishing Heartburn and Related Symptoms Source: New York, NY: W.W. Norton and Company. 1996. 192 p. Contact: Available from W.W. Norton and Company, Inc. 500 Fifth Avenue, New York, NY 10110. (212) 354-5500. PRICE: $23.00. ISBN: 0393038637. Summary: This book offers readers an abundance of information on heartburn, related symptoms, and complications. The introductory chapter relates facts and myths about heartburn, and includes a historical perspective of the diagnosis and treatment of the condition. Chapter 2 offers lifestyle modifications that may provide simple heartburn relief. Chapters 3 and 4 discuss acid and antacids, and acid disease (gastroesophageal reflux disease, or GERD). Chapter 5 updates readers on current medications available for heartburn. Chapter 6 explores the relationship between asthma and acid reflux. Chapter 7 outlines the ear, nose, and throat complications that can arise from acid reflux conditions. And Chapter 8 helps readers differentiate between 'indigestion' and cardiovascular problems (heartburn or heart attack). The concluding chapter reviews the medications and lifestyle recommendations available and encourages readers to take charge of their heartburn. The book concludes with a glossary and a subject index.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “heartburn” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “heartburn” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “heartburn” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

50 Ways to Relieve Heartburn, Reflux and Ulcers by M. Sara Rosenthal; ISBN: 0737304723; http://www.amazon.com/exec/obidos/ASIN/0737304723/icongroupinterna

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Controlling heartburn; ISBN: 0891190252; http://www.amazon.com/exec/obidos/ASIN/0891190252/icongroupinterna

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Coping with Chronic Heartburn by Elaine Fantle Shimberg (Author); ISBN: 0312982062; http://www.amazon.com/exec/obidos/ASIN/0312982062/icongroupinterna

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Coping With Chronic Heartburn: What You Need to Know About Acid Reflux and Gerd by Elaine Fantle Shimberg (2001); ISBN: 031226884X; http://www.amazon.com/exec/obidos/ASIN/031226884X/icongroupinterna

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Coping With Ulcers, Heartburn, and Stress-Related Stomach Disorders by Judy Monroe (2000); ISBN: 082392971X; http://www.amazon.com/exec/obidos/ASIN/082392971X/icongroupinterna

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Cure Indigestion, Heartburn, Cholesterol, Triglyceride & Liver Problems with Artichoke Extract by Gary Ross, et al; ISBN: 1893910016; http://www.amazon.com/exec/obidos/ASIN/1893910016/icongroupinterna

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Curing Common Complaints: From Bad Breath to Fatigue, Heartburn and Tooth Stains: The Best Doctor-Tested Tips to Relieve Everyday Health Concerns (The Family Home Remedies Collection) by Prevention Magazine (Editor); ISBN: 0875962629; http://www.amazon.com/exec/obidos/ASIN/0875962629/icongroupinterna

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Digestive Health Now: The Four Week Plan to Heal Heartburn, Ulcers, Colitis, Ibs and More by Andrew Gaeddert (2002); ISBN: 155643426X; http://www.amazon.com/exec/obidos/ASIN/155643426X/icongroupinterna

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Eating for Acid Reflux: A Handbook and Cookbook for Those with Heartburn by Jill Sklar, Annabel Cohen; ISBN: 1569244928; http://www.amazon.com/exec/obidos/ASIN/1569244928/icongroupinterna

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Freedom from Digestive Distress: Medicine-Free Relief from Heartburn, Gas, Bloating, and Irritable Bowel Syndrome by Gary L. Gitnick, Karen Cooksey (2000); ISBN: 0812932625; http://www.amazon.com/exec/obidos/ASIN/0812932625/icongroupinterna

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Gastrointestinal Health : A Self-Help Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome, Ulcers, Heartburn, Gas, Constipation by Steven R. Peikin; ISBN: 0060984058; http://www.amazon.com/exec/obidos/ASIN/0060984058/icongroupinterna

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Gastrointestinal Health Third Edition : The Proven Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome (IBS), Ulcers, Gas, Constipation, Heartburn, and Many Other Digestive Disorders by Steven R. Peikin (Author); ISBN: 0060585323; http://www.amazon.com/exec/obidos/ASIN/0060585323/icongroupinterna

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Healing Heartburn (Johns Hopkins Press Health Book) by Lawrence J. Cheskin, Brian E., Md. Lacy (2002); ISBN: 0801868696; http://www.amazon.com/exec/obidos/ASIN/0801868696/icongroupinterna

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Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson (Author) (2000); ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna

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Healthy Digestion: A Natural Approach to Relieving Indigestion, Gas, Heartburn, Constipation, Colitis & More by David Hoffmann, David Hoffman; ISBN: 1580172504; http://www.amazon.com/exec/obidos/ASIN/1580172504/icongroupinterna

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Heartburn by Nora Ephron (1996); ISBN: 0679767959; http://www.amazon.com/exec/obidos/ASIN/0679767959/icongroupinterna

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Heartburn (Harlequin Heartbeat) by Barbara Hart (Author); ISBN: 0373512686; http://www.amazon.com/exec/obidos/ASIN/0373512686/icongroupinterna

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Heartburn (Pocket Doc Library Patient Guide) by Randy J. Shields (1997); ISBN: 1888886072; http://www.amazon.com/exec/obidos/ASIN/1888886072/icongroupinterna

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Heartburn and What to Do About It by James F. Balch, et al; ISBN: 0895297922; http://www.amazon.com/exec/obidos/ASIN/0895297922/icongroupinterna

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Heartburn: Blazing Hot Worship - A Six-Week Study of the Psalms with CD (Audio) by Rick Bundschuh, Dale Reeves (Editor) (1999); ISBN: 0784709300; http://www.amazon.com/exec/obidos/ASIN/0784709300/icongroupinterna

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Heartburn: Extinguishing the Fire Inside by M. Michael Wolfe, Thomas J. Nesi (Contributor) (1997); ISBN: 0393316343; http://www.amazon.com/exec/obidos/ASIN/0393316343/icongroupinterna

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History and Heartburn: The Saga of Australian Film, 1896-1978 by Eric Reade (1980); ISBN: 0838630820; http://www.amazon.com/exec/obidos/ASIN/0838630820/icongroupinterna

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How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux by Anil Minocha (Author), Christine Adamec (Author); ISBN: 0471391395; http://www.amazon.com/exec/obidos/ASIN/0471391395/icongroupinterna

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Indigestion, Heartburn & Stomach Ulcer: Bonfire in the Belly by Macey Casebeer (1997); ISBN: 0964554658; http://www.amazon.com/exec/obidos/ASIN/0964554658/icongroupinterna

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Indigestion: Living Better With Upper Intestinal Problems from Heartburn to Ulcers and Gallstones by Henry D. Janowitz (1992); ISBN: 0195063082; http://www.amazon.com/exec/obidos/ASIN/0195063082/icongroupinterna

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Living with Chronic Heartburn by Paulo Pacheco, Marilyn Olson; ISBN: 1578261023; http://www.amazon.com/exec/obidos/ASIN/1578261023/icongroupinterna

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No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, Sherry, Md. Rogers (2000); ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna

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Nouvelle Yenta Cookbook: Farewell to Heartburn Hotel by Jeannie Sakol, Jeanne Sakol; ISBN: 0942637488; http://www.amazon.com/exec/obidos/ASIN/0942637488/icongroupinterna

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Rubber Chickens for the Soul: 50 1 2 Tales to Rekindle Your Heartburn by Bad Dog Press Editors, Bad Dog Press (1996); ISBN: 1887317031; http://www.amazon.com/exec/obidos/ASIN/1887317031/icongroupinterna

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Stop the Heartburn: What You Can Do to Reduce Your Symptoms of One of Americas Most Common Health Problems by David S. Utley, et al (1997); ISBN: 0965092801; http://www.amazon.com/exec/obidos/ASIN/0965092801/icongroupinterna

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The Bible Cure for Heartburn and Indigestion (Fitness and Health) by Donald, Md. Colbert, Don Colbert (1999); ISBN: 0884196518; http://www.amazon.com/exec/obidos/ASIN/0884196518/icongroupinterna

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The Fire Inside: Extinguishing Heartburn and Related Symptoms by M. Michael Wolfe, Thomas Nesi (Contributor) (1996); ISBN: 0393038637; http://www.amazon.com/exec/obidos/ASIN/0393038637/icongroupinterna

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The Natural No-Heartburn Cookbook by Karin Cadwell; ISBN: 0806959703; http://www.amazon.com/exec/obidos/ASIN/0806959703/icongroupinterna

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The Ulcer Story: The Authoritative Guide to Ulcers, Dyspepsia, and Heartburn by W. Grant Thompson; ISBN: 0306452758; http://www.amazon.com/exec/obidos/ASIN/0306452758/icongroupinterna

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Users Guide to Healthy Digestion: Learn How You Can Put an End to Heartburn, Indigestion, Constipation, and Other Digestive Problems by Victoria Toews Dolby, Victoria Dolby Toews (2003); ISBN: 1591200857; http://www.amazon.com/exec/obidos/ASIN/1591200857/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “heartburn” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •

Heartburn Author: Bilhartz, Lyman.; Year: 1992; [Dallas: University of Texas Southwestern Medical School, 1992]

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On the severer forms of heartburn and indigestion, especially those which arise from constitutional causes. Author: Hunt, Henry,; Year: 1992; London, Churchill, 1854

Chapters on Heartburn In order to find chapters that specifically relate to heartburn, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and heartburn using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “heartburn” (or

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on heartburn: •

Dysphagia, Odynophagia, Heartburn, and Other Esophageal Symptoms Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 93-101. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: Occasional esophageal complaints are common and usually are not harbingers of disease. However, frequent or persistent dysphagia (swallowing difficulty), odynophagia (painful swallowing), or heartburn immediately suggests an esophageal problem that necessitates investigation and treatment. This chapter on dysphagia, odynophagia, heartburn, and other esophageal symptoms is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include the mechanisms and classification of dysphagia, odynophagia, the symptoms and mechanisms of heartburn, globus sensation, chest pain, and respiratory, ear, nose and throat, and cardiac symptoms of esophageal problems. The author stresses that in particular, gastroesophageal reflux disease (GERD) may manifest with atypical complaints and should not be missed, because it is readily treatable. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 1 figure. 5 tables. 73 references.

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Acid in the Gullet: Heartburn, Esophagitis, and Hiatal Hernia Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 41-57. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. PRICE: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on acid related problems (heartburn, esophagitis, and hiatal hernia) is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author reviews each of these three problems, covering their causes, symptoms, and the physiology of what is happening. Heartburn arises in the esophagus and results from the presence of the stomach's acid contents in the lower end of the esophagus. The acid has a direct irritating result because tissues there are not normally exposed to or prepared for the acid (compared to the stomach, which has a protective mucosal lining). The most important anatomical device protecting against heartburn is the lower esophageal sphincter (LES, which guards the opening between the esophagus and the stomach). The author explores the problem that can arise with a hiatal hernia, which can impair the LES's ability to prevent reflux of the stomach's contents into the esophagus. The LES pressure is also affected after a meal of fatty foods, by smoking, and by the presence of acid in the stomach (including the role of stomach emptying). The author also discusses diagnostic testing for acid reflux; treatment options, including habits and dietary modifications, and drug therapy; and general measures for relieving heartburn, including the role of exercise. Following is a discussion of the condition of active

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inflammation of the esophagus (esophagitis), including its diagnosis, medical treatment, surgery, and the problem of Barrett's esophagus. The chapter concludes with a discussion of the treatment options for hiatal hernia, focusing on the decision about surgical treatment for the condition.

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CHAPTER 6. MULTIMEDIA ON HEARTBURN Overview In this chapter, we show you how to keep current on multimedia sources of information on heartburn. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on heartburn is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “heartburn” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “heartburn” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on heartburn: •

GERD: Beyond Heartburn Source: Princeton, NJ: Films for the Humanities and Sciences. 1998. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail: [email protected]. Website: www.films.com. PRICE: $99.00 plus shipping and handling. Order number BXA7956. Summary: Every year, more than 19 million Americans suffer from gastroesophageal reflux disease (GERD). This potentially serious digestive disorder is often mistaken for heartburn by sufferers. In this program, Dr. Malcolm Robinson, president and director of the Oklahoma Foundation for Digestive Research, and David Earnest, Professor of Medicine, Gastroenterology Section, University of Arizona Health Sciences Center, discuss the symptoms of GERD, its physiological causes, and what can be done to treat it. The video is set up like a news program, with a reporter narrating the information. Topics covered include a definition of GERD and how it differs from simple heartburn;

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the typical symptoms (burning discomfort behind the breastbone, chest pain, hoarseness, and asthma); the physiology of GERD; treatment options, including lifestyle modifications, H2 receptor antagonists, proton pump inhibitors, prokinetic drugs, and antireflux surgery; how antacids work to neutralize acid in the esophagus; esophageal complications, including Barrett's esophagus, ulceration, bleeding, and stricture (narrowing); tests used for diagnosis, including barium x ray, endoscopy, and pH measurement; and how to know which specialty of medicine handles GERD and other gastrointestinal problems (minor problems can be handled by a primary care physician, but more severe complaints should be seen by a gastroenterologist). The program features numerous interviews with patients, who describe how it feels to have GERD, and graphics that depict its mechanisms of action. •

Extinguishing Heartburn Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1995. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 091395A. Summary: Heartburn, or acid indigestion, can limit daily activities and productivity. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of heartburn are covered. Dr. Wyman stresses that any chest pain requires a medical evaluation to rule out other causes such as heart disease. Dr. Wyman defines heartburn as a symptom of gastroesophageal reflux disease (GERD), which is the reflux or return of stomach contents into the esophagus. Dr. Wyman reviews the anatomy and physiology of the gastrointestinal (GI) tract, including the lower esophageal sphincter (LES) and LES pressures. Risk factors for GERD include certain diet and lifestyle choices, smoking, obesity, pregnancy, and the regular use of certain foods and beverages. The program then reviews tips to control heartburn, including elevate the head of the bed, lose any excess weight, do not lie down immediately following a meal, and decrease portion size at mealtimes. Dr. Wyman recommends that people coping with heartburn eliminate acidic foods and any other foods that cause individual symptoms from their diet. The program briefly covers the use of antacids and the role of hiatal hernia and reflux. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

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Nighttime Heartburn Source: Bethesda, MD: American Gastroenterological Association (AGA). 2001. (videocassette). Contact: Available from American Gastroenterological Association (AGA). Digestive Disease Week (DDW), 7910 Woodmont Avenue, Suite 700, Bethesda, MD 20814-3015. (301) 272-0022. Fax (301) 654-3978. Website: www.ddw.org. PRICE: Single copy free to patient. Summary: These instructional materials support the Nighttime Heartburn Relief Effort, an initiative aimed at bringing important messages about nighttime heartburn to Americans, and educating physicians and their patients about the potential dangers associated with nighttime heartburn, as well as treatment options. The program was

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launched in response to a recent survey that examined prevalence, severity, and sufferers' satisfaction with current treatments and attitudes toward the condition. The materials define gastroesophageal reflux (the return of stomach contents, including acidic gastric juices, back up into the esophagus), and note that when sleeping and in the prone position, there is more pressure on the esophagus and the esophagus is less able to clear the acid reflux. And, because acid may linger longer in the esophagus at night, nighttime heartburn can also lead to inflammation, scarring, and a resulting risk for asthma and cancer. The program reviews treatment options, including lifestyle changes and medications, and helps viewers know when to contact their health care provider for diagnosis and additional treatment help. •

Heartburn Sufferers: Stop Taking Chances Source: Arlington, VA: American College of Gastroenterology. 199x. (videorecording). Contact: Available from American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. (800) 478-2876. PRICE: Single copy free. Summary: This patient education videotape explains the basics of heartburn and gastroesophageal reflux disease (GERD). Gastroesophageal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus. Frequent problems with reflux (two or more times per week), food sticking, or blood or weight loss, may indicate the more severe problem of GERD. The program discusses causes of heartburn and GERD, treatments for infrequent heartburn, and complications of GERD. Discussion of treatment options for GERD covers lifestyle modification, medications often prescribed (H2 receptor antagonists, proton pump inhibitors, and promotility agents), and surgery. Other topics include the effectiveness of different therapies for GERD, the role of gastroenterologists, diagnostic tests (upper GI series, endoscopy, esophageal manometry or esophageal pH), and the link between duration of heartburn and severity of esophageal disease. The program emphasizes that heartburn is a common but not trivial problem, and encourages readers to consult their health care providers for ongoing problems with heartburn. The program features Dr. Joel Richter from The Cleveland Clinic.

Bibliography: Multimedia on Heartburn The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in heartburn (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on heartburn: •

Chronic heartburn surgery [videorecording] Source: a presentation of Films for the Humanities & Sciences; produced for the Learning Channel by Advanced Medical Productions, Inc; Year: 1996; Format: Videorecording; [United States]: Discovery Communications, c1996

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Complications of heartburn [videorecording] Source: Faculty of Health Sciences, McMaster University. [et al.]; Year: 1976; Format: Videorecording; [Hamilton, Ont.]: The University, 1976

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GERD [videorecording]: beyond heartburn Source: ITV, Information Television Network, in cooperation with the American Gastroenterological Association; directors, Ana Cristina Lerner, Ed Lerner; producers, Penelope Douglas, Clara Wilkerson; writer Bill Shomo; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1998

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Heartburn that's getting worse [videorecording]: is it GERD? Source: [HSTN]; Year: 2001; Format: Videorecording; Carrollton, TX: PRIMEDIA Workplace Learning, c2001

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Nighttime heartburn relief effort [videorecording]: waking up America to a serious burning issue Source: American Gastroenterological Association; Year: 2003; Format: Videorecording; [Bethesda, Md.]: American Gastroenterological Association, 2003

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CHAPTER 7. PERIODICALS AND NEWS ON HEARTBURN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover heartburn.

News Services and Press Releases One of the simplest ways of tracking press releases on heartburn is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “heartburn” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to heartburn. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “heartburn” (or synonyms). The following was recently listed in this archive for heartburn: •

Co-pays drive patients to switch heartburn meds Source: Reuters Health eLine Date: February 12, 2003

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Continuous positive airway pressure relieves nocturnal heartburn Source: Reuters Industry Breifing Date: January 17, 2003

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FDA panel to review Boston Scientific polymer therapy for heartburn Source: Reuters Industry Breifing Date: January 16, 2003

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Treating sleep disorder eases heartburn, too Source: Reuters Health eLine Date: January 13, 2003

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Wait on Prilosec ruling gives drugmakers heartburn Source: Reuters Health eLine Date: September 11, 2002

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FDA approves TAP's Prevacid for treating heartburn in children Source: Reuters Industry Breifing Date: August 05, 2002

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Fat worsens heartburn without raising acid level Source: Reuters Health eLine Date: October 16, 2001

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Drug co. to fight jury award to heartburn-drug users Source: Reuters Health eLine Date: October 02, 2001

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Drug firms on trial in Miss. for heartburn medication Source: Reuters Industry Breifing Date: September 07, 2001

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Step-up and step-down regimens less effective than continuous lansoprazole for heartburn Source: Reuters Industry Breifing Date: July 06, 2001 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at

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http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “heartburn” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “heartburn” (or synonyms). If you know the name of a company that is relevant to heartburn, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “heartburn” (or synonyms).

Newsletters on Heartburn Find newsletters on heartburn using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “heartburn.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “heartburn” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Sound Advice: Protect Your Ears in Noisy Work Environments Source: Safeworker. 74(2): 1-15. February 2000. Contact: Available from National Safety Council. 1121 Spring Lake Drive, Itasca, IL 60143-3201. (800) 621-7619 or (630) 775-2056. Website: www.nsc.org. Summary: This newsletter reviews the importance of protecting one's hearing in noisy work environments. Published in a handy pocket size, the newsletter includes four articles: a review of the hazards of noise at work; an article describing the different types of hearing protection and how to choose the right one for each situation; a brief summary of recent health news regarding heartburn and the genetics of bad backs; and a question and answer column that considers common questions about hearing protection. The newsletter is illustrated with black and white line drawings. This issue of the newsletter is a collaboration between the National Safety Council and the National Institute for Occupational Safety and Health (NIOSH). 3 figures.

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “heartburn” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on heartburn: •

Acid Blockers: How You Can Head Off Heartburn Before It Starts Source: Mayo Clinic Health Letter. 15(11): 7. November 1997. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This brief article from a health newsletter reviews the use of acid blockers or H2 blockers. These drugs have recently become available over the counter (OTC) and can be labelled as acid blockers, acid reducers, or acid controllers. The article explores the use of these medications for treating mild to moderate heartburn, the causes of heartburn, and how OTC acid blockers work. Heartburn results from gastroesophageal reflux, a condition in which stomach acids back up (reflux) into the esophagus. The result is a burning pain behind the breastbone, often accompanied by a sour taste and the sensation of food coming back into the mouth. OTC acid blockers work by blocking the effects of histamine, a chemical that signals the stomach cells to produce acid. Acid blockers differ from traditional antacids in that they can prevent heartburn, not just relieve it. The author reviews possible drug interaction problems (notably Tagamet HB with the asthma drug theophylline, the blood thinner warfarin, or the seizure drug phenytoin). The article stresses that the best way to control heartburn is to determine and avoid what is triggering the attacks. OTC acid blockers and antacids can be helpful for occasional bouts of heartburn, but they aren't meant for severe symptoms or to be taken daily or several times a week. 2 figures. (AA-M).

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Heartburn: The Hazards Source: Inside Tract: Maintaining Your Digestive Health. p. 1, 5. March 1992. Contact: Available from Glaxo Institute for Digestive Health. P.O. Box 2032, est Caldwell, NJ 07007-9711. (800) 232-4434. PRICE: Single copy free. Summary: This brief article, from a patient education newsletter, reviews the hazards associated with heartburn. The article provides information about causes of heartburn; heartburn symptoms; knowing when to consult a health care provider; and the use of over-the-counter antacids, and the side effects of antacids. The article includes a checklist of symptoms for readers to consider.

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Heartburn: Don't Ignore the Fire Source: Mayo Clinic Health Letter. 18(8): 1-3. August 2000. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465.

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Summary: This health newsletter article reviews heartburn, the burning sensation behind the breastbone, often accompanied by a sour taste in the back of the mouth. Heartburn is the result of stomach acid flowing up into the esophagus (gastroesophageal reflux). The article reviews the anatomy of the stomach and esophagus, and notes the factors that can result in heartburn, including simply overeating, or a weakened or abnormally relaxed esophageal sphincter. Frequent heartburn is called gastroesophageal reflux disease (GERD); people with GERD may also experience nausea, sore throat, hoarseness, wheezing, and a cough. Untreated, GERD can lead to inflammation of the esophagus (esophagitis) or to a precancerous condition called Barrett's esophagus. The article focuses on practical strategies to help prevent heartburn: control weight, avoid foods or beverages that can trigger heartburn, wear loose clothing, avoid lying down for 2 hours after eating, do not smoke, chew gum after meals, and drink adequate water when taking medications. Along with these lifestyle changes, nonprescription drugs that reduce painful stomach acid may relieve mild and occasional heartburn. These drugs include antacids and H2 blockers such as famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac), and cimetidine (Tagamet). When heartburn becomes frequent, readers are counseled to seek medical assistance. Diagnosis may include endoscopy and a pH monitoring test. After diagnosis, prescription medications may include stronger H2 blockers and proton pump inhibitors such as lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex). Surgery may be indicated when drug therapy and lifestyle changes are not effective. One sidebar reports on new endoscopic treatments for heartburn; another sidebar cautions readers about the side effects of chronic heartburn. 1 figure.

Academic Periodicals covering Heartburn Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to heartburn. In addition to these sources, you can search for articles covering heartburn that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for heartburn. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with heartburn. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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Heartburn

following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to heartburn: Acetaminophen, Sodium Bicarbonate, and Citric Acid •

Systemic - U.S. Brands: Bromo-Seltzer http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202005.html

Antacids •

Oral - U.S. Brands: Advanced Formula Di-Gel; Alamag; Alamag Plus; Alenic Alka; Alenic Alka Extra Strength; Alka-Mints; Alkets; Alkets Extra Strength; Almacone; Almacone II; AlternaGEL; Alu-Cap; Aludrox; Alu-Tab; Amitone; Amphojel; Antacid Gelcaps; Antacid Liquid; Antacid L http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202047.html

Bismuth Subsalicylate •

Oral - U.S. Brands: Bismatrol; Pepto-Bismol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202092.html

Cisapride •

Systemic - U.S. Brands: Propulsid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202672.html

Histamine H 2 -Receptor Antagonists •

Systemic - U.S. Brands: Axid; Axid AR; Mylanta AR Acid Reducer; Pepcid; Pepcid AC Acid Controller; Pepcid I.V.; Pepcid RPD; Tagamet; Tagamet HB; Zantac; Zantac EFFERdose Granules; Zantac EFFERdose Tablets http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202283.html

Metoclopramide •

Systemic - U.S. Brands: Octamide; Reglan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202364.html

Sodium Bicarbonate •

Systemic - U.S. Brands: Bell/ans; Citrocarbonate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202525.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “heartburn” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 2156 23 244 5 0 2428

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “heartburn” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on heartburn can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to heartburn. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to heartburn. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “heartburn”:

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•

Other guides Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Esophagus Disorders http://www.nlm.nih.gov/medlineplus/esophagusdisorders.html Gastroesophageal Reflux/Hiatal Hernia http://www.nlm.nih.gov/medlineplus/gastroesophagealrefluxhiatalhernia.html Peptic Ulcer http://www.nlm.nih.gov/medlineplus/pepticulcer.html Scleroderma http://www.nlm.nih.gov/medlineplus/scleroderma.html Stomach Cancer http://www.nlm.nih.gov/medlineplus/stomachcancer.html Stomach Disorders http://www.nlm.nih.gov/medlineplus/stomachdisorders.html

Within the health topic page dedicated to heartburn, the following was listed: •

General/Overviews Heartburn Source: American Gastroenterological Association http://www.gastro.org/clinicalRes/brochures/heartburn.html Heartburn Myths and Facts Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/1010.jsp Heartburn Overview Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/1005.jsp

•

Diagnosis/Symptoms Esophageal Muscle Test (Manometry) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com//invoke.cfm?id=AN00340 Gastric Analysis Source: National Institutes of Health, Clinical Center http://www.cc.nih.gov/ccc/patient_education/procdiag/gastricanaly.pdf Heartburn or Heart Attack? Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/1030.jsp Upper GI Series Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/uppergi/index.htm

Patient Resources

•

Treatment Medication Chart Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/1045.jsp

•

Nutrition Stocking the Pantry Source: National Heartburn Alliance http://www.heartburnalliance.org/section4/7110.jsp Stop and Select Guide Source: National Heartburn Alliance http://www.heartburnalliance.org/section4/6008.jsp

•

Specific Conditions/Aspects Alcohol Consumption and Heartburn Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/alcohol.jsp Halt Holiday Heartburn Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/holiday.jsp Heartburn's Hidden Effects Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/consequences.jsp Nighttime Heartburn http://www.gastro.org/pdf/Brochure_51001.pdf Smoking and Heartburn Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/smoking.jsp Sufferers Point to Stress as an Aggravator of Heartburn Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/1001.jsp Weighty Side of Heartburn Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/weight.jsp

•

Organizations American College of Gastroenterology http://www.acg.gi.org/ American Gastroenterological Association http://www.gastro.org/ National Heartburn Alliance http://www.heartburnalliance.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

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Prevention/Screening Heartburn-Friendly Cooking Techniques Source: National Heartburn Alliance http://www.heartburnalliance.org/section4/7111.jsp Tips to Combat Exercise-Induced Heartburn Source: National Heartburn Alliance http://www.heartburnalliance.org/section3/exercise.jsp

•

Statistics 2003 Survey Results: The Burn Factor Source: National Heartburn Alliance http://www.heartburnalliance.org/nosection/2003SurveyResults.jsp National Heartburn Alliance Survey Results Source: National Heartburn Alliance http://www.heartburnalliance.org/nosection/results0.jsp

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on heartburn. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Gastroesophageal Reflux Disease: More Than Heartburn Source: American Family Physician. 60(3): 885-886. September 1, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Gastroesophageal reflux disease (GERD) is the most common esophageal disease. Besides the typical presentation of heartburn and acid regurgitation, either alone or in combination, GERD can cause atypical symptoms. This patient education handout reviews these symptoms, and how they are treated. Sometimes GERD can cause problems in the throat, making the patient feel as if there is a lump in the throat or creating an urge to clear the throat. GERD can also cause burning sensations in the mouth, trouble swallowing, dry mouth, bad breath, or even pain in the ears. It is diagnosed by the symptoms and then treated with traditional medications. Patients are encouraged to accompany any drug therapy with lifestyle changes, including limiting certain foods, stopping smoking, not drinking alcohol, losing weight (if needed), eating

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smaller meals, avoiding eating and drinking about 4 hours before going to bed, and raising the head of the bed. The handout briefly reviews the medications that may be used and the differences between the prescription and over the counter versions of these drugs. •

Understanding Heartburn and Reflux Disease Source: Indianapolis, IN: Eli Lilly and Company. 1993. 6 p. Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN 46285. (317) 276-2000. PRICE: Single copy free. Summary: This booklet describes gastroesophageal reflux disease (GERD) and some of its symptoms, including heartburn. Topics include the anatomy and function of the stomach and esophagus; habits and conditions that can worsen reflux symptoms; factors that influence muscle valve pressure; symptoms to watch for; complications; diagnostic methods; and treatment options, including lifestyle adjustments, medication, and surgery. The booklet stresses that maintaining a positive attitude, working in tandem with one's health care provider, and complying with treatment advice are the best ways to manage reflux disease. 4 figures. 1 table. 11 references.

•

'I'm Taking Medicine for Frequent Heartburn. Why Am I Still Suffering?': A Patient Information Resource About Symptomatic Acid Reflux Disease Source: [Wayne, PA]: Astra Merck Inc. 1997. 15 p. Contact: Available from Astra Merck Inc. (800) 336-9992. PRICE: Single copy free. Summary: This booklet provides readers with basic information about heartburn and gastroesophageal reflux disease (GERD). The brochure encourages readers to ask their physicians about omeprazole (Prilosec), a drug therapy for heartburn and other symptoms associated with GERD. The brochure notes that if heartburn is present two or more times a week, GERD may be present. The author outlines the incidence of heartburn, the symptoms of GERD (heartburn, sour or bitter taste, difficult or painful swallowing), the causes of GERD symptoms, why GERD symptoms occur so frequently, how the stomach makes acid, and the action of acid pump inhibitors, such as omeprazole. GERD symptoms happen when juices containing harsh acid back up from the stomach into the esophagus. Included with the brochure is the package insert information from Prilosec. The brochure is illustrated with humorous, colorful line drawings of a variety of patients with heartburn and GERD. Blank space is available for notes or questions to ask the health care provider. (AA-M).

•

What You Should Know About Heartburn Source: Postgraduate Medicine. 101(2): 186. February 1997. Summary: This brief patient handout summarizes heartburn, a common problem in adults. Heartburn occurs when stomach acid backs up into the esophagus, causing pain under the breastbone. This usually happens just after a meal or when lying down or bending over. The fact sheet notes that certain foods and activities aggravate the problem and should be avoided. These include caffeinated coffee, chocolate, fatty red meat, pizza, tomatoes, smoking, and alcoholic beverages. Heartburn can also be made worse by excess weight or by eating within 3 hours of bedtime. The fact sheet recommends some simple lifestyle modifications, including raising the head of the bed, that may help. The fact sheet also briefly mentions diagnostic tests and drug therapy

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that may be used to help manage heartburn. The fact sheet concludes with a World Wide Web address for readers wishing more information. •

Heartburn? Source: Madison, NJ: Whitehall Laboratories. 1994. 6 p. Contact: Available from Whitehall-Robins Health Care, c/o Dr. E. Ashraf. 5 Giralda Farms, Madison, NJ 07940-0871. (201) 660-5677. PRICE: Single copy free. Summary: This brochure describes heartburn or acid indigestion. Written in a questionand-answer format, the brochure covers topics including a definition of heartburn; the causes of heartburn; suggestions for overcoming heartburn; and the use of antacids. The brochure concludes with a checklist of suggestions for overcoming heartburn. Also included is information about Riopan brand of antacid; a coupon for the product is provided.

•

Sometimes Heartburn is More Than Just Heartburn: Sometimes It's GERD (Gastroesophageal Reflux Disease) Source: Wayne, PA: Astra Merck. 1996. 4 p. Contact: Available from Astra Merck Information Center. 725 Chesterbrook Boulevard, Wayne, PA 19087-5677. (800) 236-9933 or (610) 695-1000. PRICE: Single copy free; bulk copies available. Summary: This brochure helps readers to differentiate between occasional mild heartburn or acid indigestion and the more serious problem of gastroesophageal reflux disease (GERD). The brochure first describes the symptoms of common heartburn and notes that the feeling of discomfort or burning tends to not last long, to be easily relieved with antacids or acid reducers, and to be prevented by dietary modifications. However, symptoms that do not fit into this description may be indicative of GERD. The brochure then describes GERD, notes its symptoms, and lists seven questions with which readers can self-diagnose their heartburn problems. The brochure also provides a series of helpful hints for managing GERD, in addition to medical treatment, by modifying lifestyle activities including dietary modification (what one eats and drinks, as well as when food intake occurs), weight loss, smoking cessation, avoiding drug interactions that may contribute to GERD, and raising the head of one's bed. The back cover of the brochure reprints the seven self-diagnostic questions contained inside.

•

Heartburn Source: Bethesda, MD: American Gastroenterological Association. 1996. 3 p. Contact: Available from GIDH-AGA Patient Education Center. P.O. Box 1274, West Caldwell, NJ 07007-9562. PRICE: 25 copies free to health care professionals for distribution to patients. Summary: This brochure provides patients with basic information about heartburn, the most common symptom of gastroesophageal reflux disease (GERD). When the lower esophageal sphincter (a muscle located between the esophagus and stomach that normally opens after swallowing) either relaxes inappropriately or is very weak, the highly acidic contents of the stomach can back up, or reflux, into the esophagus. In addition to heartburn, symptoms of GERD may include persistent sore throat, laryngitis, nighttime or chronic cough, asthma, and a feeling of a lump in the throat. The author discusses how heartburn occurs, the symptoms of heartburn, tips to control heartburn,

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diagnostic tests used to confirm chronic disease, the interrelationship of hiatal hernia and heartburn, treatment options for heartburn, and the complications of longterm reflux and heartburn. The brochure concludes with a glossary of terms. 2 figures. 2 references. (AA-M). •

Heartburn: Nothing to do with the Heart Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 2000. [2 p.]. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217-8076. (888) 964-2001 or (414) 964-1799. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $1.00 for nonmembers; single copy free to members. Summary: This brochure reviews heartburn, defined as a burning sensation in the chest behind the breastbone. The author first reviews the terminology and differentiates between heartburn and dyspepsia (pain in the upper abdomen that resembles that of a peptic ulcer), then describes how heartburn is caused. When gastric (stomach) acids escapes back from the stomach into the esophagus (gastroesophageal reflux), it irritates or damages the esophagus, resulting in heartburn. The author describes the role of the lower esophageal sphincter (LES), which acts as a gate or valve between the esophagus and stomach, and what happens when the LES is weakened or malfunctioning. The author discusses the importance of eating smaller meals and not lying down immediately after a meal, in order to prevent reflux. In addition, certain foods compromise the sphincter's ability to prevent reflux; these foods differ from person to person, but many recognize fats, onions, and chocolate as particularly troublesome. The author reviews other conditions (such as overweight) that can make heartburn worse and summarizes the drugs that may be used to help treat heartburn. One sidebar summarizes basic facts about GERD. The brochure concludes with a brief description of the International Foundation for Functional Gastrointestinal Disorders (IFFGD), a nonprofit education and research organization (www.iffgd.org).

•

Functional Heartburn Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders. 1997. 1 p. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $0.50. Summary: This fact sheet provides basic information about functional heartburn, a disorder characterized by episodes of burning discomfort in the chest, behind the breastbone. There is no evidence of inflammation in the lining of the esophagus, nor of other disease. The discomfort generally comes in waves, occurs after meals, and can be accompanied by belching, regurgitation, or dyspeptic symptoms such as upper abdominal discomfort, bloating, or an early feeling of being full. If the symptoms of functional heartburn are episodic, short lasting, and well controlled with antacids, then diagnostic tests are not needed. With more severe symptoms, diagnostic tests will be performed to rule out esophagitis and gastroesophageal reflux disease (GERD). The author describes the possible interactions between stress and reflux or heartburn symptoms. The fact sheet concludes with a discussion of treatment strategies ranging from lifestyle changes to medications. Relaxation therapy may also prove useful for patients with functional heartburn symptoms. (AA-M).

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•

Gastroesophageal Disease (Hiatal Hernia and Heartburn) Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2001. 6 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 6543810. Fax (301) 634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: Full-text available online at no charge; single copy free; bulk copies available. Order number: DD-160. Summary: This fact sheet provides information on gastroesophageal reflux disease (GERD), a digestive disorder that affects the lower esophageal sphincter (LES) that connects the esophagus with the stomach. Written in a question-and-answer format, the fact sheet addresses causes, symptoms, treatment, and long-term complications of GERD. Specific topics include the role of hiatal hernia; how dietary and lifestyle choices may contribute to GERD; heartburn pain and how to control it; non-pharmaceutical treatment options for GERD; and diagnostic tests used to establish a diagnosis of GERD, including upper GI series, endoscopy, the Bernstein test, and esophageal manometry. The fact sheet also includes a description of the National Digestive Diseases Information Clearinghouse. 2 figures. 4 references.

•

Cramps, Bloating and Heartburn Contact: AIDS Services of Austin, PO Box 4874, Austin, TX, 78765-9836, (512) 458-2437, http://www.asaustin.org. Summary: This fact sheet suggests foods and eating practices for persons experiencing cramps, bloating, and heartburn, which are often associated with Acquired immunodeficiency syndrome (AIDS), caused by Human immunodeficiency virus (HIV).

•

Coping with Heartburn and Reflux Source: Research Triangle Park, NC: Glaxo Pharmaceuticals. 1992. 1 p. Contact: Available from Glaxo Pharmaceuticals. Five Moore Drive, Research Triangle Park, NC 27709. (919) 248-2100. PRICE: Single copy free. Summary: This fact sheet, in the form of a small poster, lists nine recommendations designed to help people cope with heartburn and reflux. The fact sheet provides information on the following topics: avoiding certain foods; limiting intake of certain beverages, particularly those with caffeine; weight loss; eating moderately; careful timing of exercise; timing of meals; smoking; elevating the bed; and consulting a health care provider. A simple line drawing illustrates each of the nine suggestions.

•

Taking Care of Heartburn or Ulcers? Source: Santa Cruz, CA: ETR Associates. 1997. 4 p. Contact: Available from ETR Associates. 4 Carbonero Way, Scotts Valley, CA 950664200. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. PRICE: Single copy free; $16.00 for 50 copies, discounts for larger orders. Order number: 006. Summary: This patient education brochure explains the basics of living with heartburn and helps readers differentiate between heartburn and ulcers. The brochure lists possible causes of the pain associated with heartburn, and notes strategies to prevent or relieve heartburn. These strategies include: eat smaller, more frequent meals; don't eat a

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large amount before going to bed; try drinking a glass of water to temporarily stop the pain; elevate the head of the bed; reduce or eliminate nicotine, caffeine, alcohol, carbonated drinks, and high fat foods; stop taking any anti-inflammatory painkiller that contains aspirin, ibuprofen, or naproxen; try looser clothing; add exercise to daily activities; maintain an appropriate weight; and try using antacids. The brochure describes the physiology of an ulcer and lists the risk factors that increase the likelihood of an ulcer. Risk factors include a bacterial infection (Helicobacter pylori infection), use of anti-inflammatory painkillers, smoking, and stress. The final section outlines a common treatment plan for ulcers and describes how patient cooperation and careful adherence to the treatment plan can cure ulcers. The brochure also lists symptoms for which a health care provider should be consulted. 1 figure. (AA-M). •

Heartburn: Hints on Dealing with the Discomfort Source: Kansas City, MO: American Academy of Family Physicians. 1994. 4 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $22.00 for 100 copies for members, $33.00 for 100 copies for nonmembers. Summary: This patient education brochure helps readers understand heartburn and how they can deal with the discomfort it may cause. Heartburn is a burning feeling in the lower chest, along with a sour or bitter taste of food in the throat and mouth. It usually occurs after eating a big meal or while lying down. Heartburn is caused by stomach contents (acid) going back up into the esophagus; this is called reflux. The stomach acid can irritate the esophagus and cause the feeling of burning pain. The brochure describes hiatus hernia, factors that can add to heartburn, complications that can arise because of heartburn, tips on preventing heartburn, the use of antacids, how to know when to consult a health care provider regarding heartburn problems, medications that can be used, and the indications for surgery. Most people get fast, short-term relief with antacids. Three kinds of medications might be used to treat heartburn. H2 blockers (Axid, Pepcid, Tagamet, Zantac) lower how much acid the stomach makes. Omeprazole (Prilosec) completely stops the stomach from making acid. Metoclopramide (Reglan) reduces reflux. Surgery is only needed when symptoms are very bad and don't go away after medicine and other measures have been tried. Simple line drawings illustrate the stomach and esophagus. 2 figures. 3 tables. (AA-M).

•

All About Heartburn and Hiatus Hernia Source: London, England: British Digestive Foundation. 1993. 3 p. Contact: Available from British Digestive Foundation. 7 Chandos Street, London W1A 2LN England. PRICE: Single copy free. Summary: This patient education brochure provides basic information about heartburn and hiatus hernia. Written in a question-and-answer format, it covers topics including definitions of heartburn and hiatus hernia; the causes of heartburn; how hiatus hernia is treated; symptoms; and how to avoid heartburn. Specific suggestions for weight loss, diet, sleeping, posture, clothing, and pregnancy are given. The brochure includes an insert summarizing guidelines for the early diagnosis of digestive disorders. This insert, entitled 'When Should I See My Doctor' lists symptoms that suggest a health care provider should be consulted. The brochure concludes with a brief description of the activities of the British Digestive Foundation.

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•

Living Comfortably With Heartburn Source: Patient Care. 30(8): 43. April 30, 1996. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This patient education handout briefly describes recommendations for living comfortably with heartburn. Topics include a definition of reflux (heartburn), treatment options, the role of environmental changes (such as propping up the head of the bed, dietary changes, and exercise), and when to consult a health care provider about reflux symptoms. 2 figures.

•

What You Can Do About Heartburn Source: American Family Physician. 52(3): 965-966. September 1, 1995. Summary: This patient information fact sheet provides guidelines on managing heartburn. Written in a question and answer format, the fact sheet covers the causes of heartburn, tips for getting relief, and drug therapy. Lifestyle modifications include using bed blocks and antacids, eating smaller meals, not lying down for 4 hours after eating, not smoking, maintaining an ideal weight, and wearing looser clothing.

•

Living with GERD: Controlling the Symptoms of Heartburn Due to GERD Source: Indianapolis, IN: Eli Lilly and Company. 1995. 7 p. Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN 46285. (800) 545-5979. PRICE: Single copy free. Summary: This pocket-sized patient information booklet provides information on controlling the symptoms of heartburn from gastroesophageal reflux disease (GERD). It describes the common causes of GERD, including food and lifestyle factors that may contribute to the problem. In addition, it addresses diagnostic tests, treatment options, and the importance of treatment for GERD. The booklet concludes with a section of questions for readers to ask themselves as a way to monitor their progress in managing GERD. 2 figures. 1 table. 6 references. Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Gastroesophageal Reflux Disease: (Hiatal Hernia and Heartburn) Summary: Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter (LES)--the muscle connecting the esophagus with the stomach. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=736

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to heartburn. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to heartburn. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with heartburn. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about heartburn. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at

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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “heartburn” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “heartburn”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “heartburn” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “heartburn” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on heartburn: •

Basic Guidelines for Heartburn Heartburn Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003114.htm Heartburn prevention Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002101.htm

•

Signs & Symptoms for Heartburn Black, tarry stools Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Blood in the stools Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm Heartburn Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003114.htm

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Overweight Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Stomach acid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003114.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Vomiting blood Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003118.htm •

Diagnostics and Tests for Heartburn Barium swallow Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm Upper GI series Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm

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Nutrition for Heartburn Coffee Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm

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Background Topics for Heartburn Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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HEARTBURN DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 5-Hydroxytryptophan: Precursor of serotonin used as antiepileptic and antidepressant. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Achlorhydria: A lack of hydrochloric acid in gastric juice despite stimulation of gastric secretion. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH]

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Aerophagia: A condition that occurs when a person swallows too much air. Causes gas and frequent belching. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alginates: Salts of alginic acid that are extracted from marine kelp and used to make dental impressions and as absorbent material for surgical dressings. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Aluminum Compounds: Inorganic compounds that contain aluminum as an integral part of the molecule. [NIH] Aluminum Hydroxide: Hydrated aluminum. A compound with many biomedical applications: as a gastric antacid, an antiperspirant, in dentifrices, as an emulsifier, as an adjuvant in bacterins and vaccines, in water purification, etc. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH]

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Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anterograde: Moving or extending forward; called also antegrade. [EU] Antianginal: Counteracting angina or anginal conditions. [EU] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or

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reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antiepileptic: An agent that combats epilepsy. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipruritic: Relieving or preventing itching. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the

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walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium swallow: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called an esophagram. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Belching: Noisy release of gas from the stomach through the mouth. Also called burping. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH]

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Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

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Brash: An uneasy burning sensation in the stomach and associated with the eructation of an acid fluid. [NIH] Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Butterflies: Slender-bodies diurnal insects having large, broad wings often strikingly colored and patterned. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carboxy: Cannabinoid. [NIH] Cardia: That part of the stomach surrounded by the esophagogastric junction, characterized by the lack of acid-forming cells. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiopathy: Any disorder or disease of the heart. In addition to heart disease of inflammatory origin, there are arteriosclerotic cardiopathy, due to arteriosclerosis; fatty cardiopathy, due to growth of fatty tissue; hypertensive cardiopathy, due to high blood pressure; nephropathic cardiopathy, due to kidney disease, thyrotoxic cardiopathy, due to thyroid intoxication; toxic cardiopathy, due to the effect of some toxin; and valvular cardiopathy, due to faulty valve action. [EU]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2

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receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P450. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Claudication: Limping or lameness. [EU] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colitis: Inflammation of the colon. [NIH] Colloidal: Of the nature of a colloid. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials

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including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contact dermatitis: Inflammation of the skin with varying degrees of erythema, edema and vesinculation resulting from cutaneous contact with a foreign substance or other exposure. [NIH]

Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

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Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dentifrices: Any preparations used for cleansing teeth; they usually contain an abrasive, detergent, binder and flavoring agent and may exist in the form of liquid, paste or powder; may also contain medicaments and caries preventives. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH]

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DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Desquamation: The shedding of epithelial elements, chiefly of the skin, in scales or small sheets; exfoliation. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuresis: Increased excretion of urine. [EU] Diurnal: Occurring during the day. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several

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systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Ellagic Acid: A fused four ring compound occurring free or combined in galls. Isolated from the kino of Eucalyptus maculata Hook and E. Hemipholia F. Muell. Activates Factor XII of the blood clotting system which also causes kinin release; used in research and as a dye. [NIH]

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Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermal Growth Factor: A 6 kD polypeptide growth factor initially discovered in mouse submaxillary glands. Human epidermal growth factor was originally isolated from urine based on its ability to inhibit gastric secretion and called urogastrone. epidermal growth factor exerts a wide variety of biological effects including the promotion of proliferation and differentiation of mesenchymal and epithelial cells. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH]

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Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Eructation: The ejection of gas or air through the mouth from the stomach. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophageal Ulcer: A sore in the esophagus. Caused by long-term inflammation or damage from the residue of pills. The ulcer may cause chest pain. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagoscopy: Endoscopic examination, therapy, or surgery of the esophagus. [NIH] Esophagram: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called a barium swallow. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excrete: To get rid of waste from the body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.

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[NIH]

Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Food Coloring Agents: Natural or synthetic dyes used as coloring agents in processed foods. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallate: Antioxidant present in tea. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric banding: Surgery to limit the amount of food the stomach can hold by closing part of it off. A band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness. [NIH]

Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Fundus: The superior portion of the body of the stomach above the level of the cardiac notch. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

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Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Ginkgo biloba: Exclusive species of the genus Ginkgo, family Ginkgoacea. It produces extracts of medicinal interest. Ginkgo may refer to the genus or species. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into

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three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histamine Agonists: Drugs that bind to and activate histamine receptors. Although they have been suggested for a variety of clinical applications histamine agonists have so far been more widely used in research than therapeutically. [NIH] Histamine Antagonists: Drugs that bind to but do not activate histamine receptors, thereby blocking the actions of histamine or histamine agonists. Classical antihistaminics block the histamine H1 receptors only. [NIH]

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Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxides: Inorganic compounds that contain the OH- group. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersecretion: Excessive secretion. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response.

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[NIH]

Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Intercellular Junctions: Strictly, and so far as it can be distinguished, the amorphous isotropic layer between adjacent primary walls of cells. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a

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gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lactose Intolerance: The disease state resulting from the absence of lactase enzyme in the musocal cells of the gastrointestinal tract, and therefore an inability to break down the disaccharide lactose in milk for absorption from the gastrointestinal tract. It is manifested by indigestion of a mild nature to severe diarrhea. It may be due to inborn defect genetically conditioned or may be acquired. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngitis: Inflammation of the larynx. This condition presents itself with dryness and soreness of the throat, difficulty in swallowing, cough, and hoarseness. [NIH]

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Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Magnesium Hydroxide: Magnesium hydroxide (Mg(OH)2). An inorganic compound that occurs in nature as the mineral brucite. It acts as an antacid with cathartic effects. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH]

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Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Assistance: Financing of medical care provided to public assistance recipients. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Metaplasia: A condition in which there is a change of one adult cell type to another similar adult cell type. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH]

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Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Molting: Casting off feathers, hair, or cuticle. Molting is a process of sloughing or desquamation, especially the shedding of an outer covering and the development of a new one. This phenomenon permits growth in arthropods, skin renewal in amphibians and reptiles, and the shedding of winter coats in birds and mammals. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucosal Lining: The lining of GI tract organs that makes mucus. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH]

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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nizatidine: A histamine H2 receptor antagonist with low toxicity that inhibits gastric acid secretion. The drug is used for the treatment of duodenal ulcers. [NIH] Nonulcer Dyspepsia: Constant pain or discomfort in the upper GI tract. Symptoms include

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burning, nausea, and bloating, but no ulcer. Possibly caused by muscle spasms. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Odynophagia: A painful condition of the esophagus. [NIH] Oesophagitis: Inflammation of the esophagus. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is

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comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paraneoplastic syndrome: A group of symptoms that may develop when substances released by some cancer cells disrupt the normal function of surrounding cells and tissue. [NIH]

Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH]

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Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation

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of, or exposure to a deleterious agent. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prokinetic Drugs: Medicines that cause muscles in the GI tract to move food. An example is

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cisapride (SIS-uh-pryd) (Propulsid). [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts.

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[NIH]

Pyloric Stenosis: Obstruction of the pyloric canal. [NIH] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Pyrosis: Heartburn. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Ranitidine: A non-imidazole blocker of those histamine receptors that mediate gastric secretion (H2 receptors). It is used to treat gastrointestinal ulcers. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Redux: Appetite suppressant. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU]

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Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resected: Surgical removal of part of an organ. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. [NIH] Retrosternal: Situated or occurring behind the sternum. [EU] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH]

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Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Self Administration: Administration of a drug or chemical by the individual under the direction of a physician. It includes administration clinically or experimentally, by human or animal. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Self Medication: The self administration of medication not prescribed by a physician or in a manner not directed by a physician. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Simethicone: A mixture of dimethyl polysiloxanes and silica gel used as an antiflatulent. Without the addition of silica gel (dimethicone), it is used as an ointment base ingredient and skin protectant. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland,

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27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Bicarbonate: A white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Sternum: Breast bone. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomachic: Medicine that acts like a tonic on the stomach. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH]

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Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Supine: Having the front portion of the body upwards. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart

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and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tips to control heartburn: ? Avoid foods and beverages that affect lower esophageal sphincter pressure or irritate the esophagus lining. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH]

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Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urea Breath Test: A test used to detect Helicobacter pylori infection. The test measures breath samples for urease, an enzyme H. pylori makes. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricular: Pertaining to a ventricle. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and

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kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX 5 5-Hydroxytryptophan, 50, 129 A Abdomen, 62, 70, 115, 129, 134, 142, 148, 150, 155, 162, 164, 166 Abdominal, 14, 69, 70, 80, 115, 129, 140, 149, 154, 155 Abdominal Pain, 14, 69, 129, 149 Acceptor, 129, 150, 154 Acetylcholine, 75, 129, 136 Achlorhydria, 75, 129 Adaptation, 129, 156 Adenocarcinoma, 9, 15, 129 Adenosine, 129, 131, 135, 156, 164 Adjustment, 71, 76, 129 Adjuvant, 129, 130 Adrenal Medulla, 129, 142, 154 Adsorption, 14, 129 Adsorptive, 129 Adverse Effect, 129, 161 Aerophagia, 63, 130 Aerosol, 130, 163 Affinity, 130, 161 Agonist, 130, 141, 153 Airway, 91, 130, 166 Alertness, 130, 135 Alginates, 64, 69, 130 Algorithms, 8, 11, 130, 134 Alimentary, 3, 4, 16, 17, 19, 20, 21, 24, 27, 28, 29, 30, 31, 33, 44, 130, 155 Alkaline, 130, 131, 133, 135 Alkaloid, 130, 152, 153, 163 Alpha Particles, 130, 159 Alternative medicine, 92, 130 Aluminum, 13, 50, 68, 130 Aluminum Compounds, 13, 130 Aluminum Hydroxide, 13, 50, 68, 130 Ameliorating, 72, 130 Amenorrhea, 131 Amine, 131, 146 Amino Acids, 131, 145, 155, 157, 158, 165 Amiodarone, 27, 131 Ammonia, 131, 165 Ampulla, 131, 142 Anal, 131, 144 Analgesic, 64, 131, 147, 152, 154 Anatomical, 85, 131, 161 Anemia, 10, 131

Anesthesia, 75, 130, 131 Animal model, 14, 131 Anions, 131, 149 Anorexia, 70, 72, 75, 131 Anorexia Nervosa, 75, 131 Antagonism, 131, 135, 164 Anterograde, 75, 131 Antianginal, 131 Antiarrhythmic, 131 Antibacterial, 131, 162 Antibiotic, 8, 131, 132, 162 Antibody, 130, 132, 137, 148 Anticoagulant, 132, 158, 166 Antidepressant, 129, 132 Antiemetic, 76, 132, 151 Antiepileptic, 129, 132 Antigen, 130, 132, 137, 147, 148 Anti-inflammatory, 64, 117, 132, 133, 140, 145, 147 Anti-Inflammatory Agents, 132, 133 Antioxidant, 58, 59, 132, 133, 144 Antipruritic, 132, 136 Anuria, 132, 149 Anus, 131, 132, 134, 144 Anxiety, 132, 155 Aqueous, 132, 133, 139, 147 Arginine, 59, 74, 132 Arterial, 132, 158 Arteries, 132, 134, 139, 151, 152 Arterioles, 132, 133, 134, 152, 165 Arteriolosclerosis, 132, 133 Arteriosclerosis, 59, 132, 135, 152 Ascorbic Acid, 59, 74, 133 Aspirin, 63, 65, 117, 133 Astringents, 133, 143 Asymptomatic, 12, 133 Atrial, 131, 133, 166 Atrial Fibrillation, 133, 166 Attenuated, 14, 133, 165 Atypical, 9, 80, 85, 112, 133 Autonomic, 14, 129, 133, 154 Autonomic Neuropathy, 14, 133 B Bacteria, 80, 129, 131, 132, 133, 134, 142, 143, 144, 151, 161, 162, 165 Barium, 6, 88, 128, 133, 143 Barium swallow, 6, 128, 133, 143 Basal cells, 65, 133

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Base, 13, 29, 38, 66, 133, 143, 145, 149, 161 Basophils, 133, 146, 150 Belching, 81, 115, 130, 133 Bile, 63, 65, 133, 134, 136, 144, 145, 149, 150 Bile Acids, 133, 134, 145 Bile Acids and Salts, 133, 134 Bile Ducts, 134, 144 Bile Pigments, 134, 149 Biliary, 85, 134, 136 Bilirubin, 134, 144, 147 Biopsy, 11, 12, 15, 22, 134 Biotechnology, 15, 16, 84, 92, 105, 134 Biotransformation, 134 Bladder, 133, 134, 144, 165 Bloating, 80, 82, 115, 116, 134, 148, 149, 154 Blood Coagulation, 134, 135 Blood Glucose, 134, 146 Blood pressure, 60, 74, 134, 135, 152, 162 Blood vessel, 134, 136, 142, 151, 155, 161, 164, 165 Body Fluids, 134, 141, 161 Body Mass Index, 134, 154 Bowel, 82, 131, 134, 140, 148, 155, 162 Bowel Movement, 134, 140, 162 Branch, 125, 134, 155, 162, 164 Brash, 61, 135 Breakdown, 135, 140, 144 Bronchi, 135, 142, 164 Bronchial, 135, 146, 164 Bronchitis, 135, 143 Butterflies, 81, 135 C Caffeine, 5, 7, 45, 116, 117, 135 Calcification, 132, 135 Calcium, 4, 40, 58, 61, 68, 74, 76, 135, 137 Calcium Carbonate, 4, 58, 68, 74, 135 Capsules, 44, 135, 141 Carbohydrates, 135, 136 Carboxy, 75, 135 Cardia, 62, 72, 135 Cardiac, 6, 65, 85, 131, 133, 135, 139, 142, 144, 152, 153 Cardiopathy, 59, 135 Cardiovascular, 81, 133, 136, 161 Cardiovascular System, 133, 136 Carotene, 50, 136 Case report, 44, 136 Cations, 136, 149 Causal, 15, 136, 160

Cell, 11, 130, 132, 133, 134, 136, 138, 139, 143, 148, 149, 151, 153, 156, 159, 160, 163, 164, 166 Cell Division, 133, 136, 156 Cell membrane, 11, 136, 149, 156 Cell proliferation, 133, 136 Cellulose, 135, 136, 156 Central Nervous System, 70, 75, 129, 135, 136, 144, 146, 152, 161, 164 Chemotherapy, 45, 136 Chest Pain, 6, 10, 29, 34, 65, 70, 80, 81, 85, 88, 136, 143 Cholesterol, 49, 82, 133, 134, 136, 144, 147 Cholestyramine, 46, 136 Cholinergic, 136, 153 Chromatin, 136, 142, 153 Chromosome, 136, 146, 150 Chronic, 6, 10, 15, 19, 27, 48, 62, 70, 72, 82, 83, 89, 95, 114, 136, 140, 143, 148, 149, 161, 163 Chronic Disease, 115, 136 Cimetidine, 7, 19, 30, 32, 51, 68, 95, 136 CIS, 19, 75, 137 Citrus, 63, 65, 133, 137 Claudication, 44, 137 Clear cell carcinoma, 137, 140 Clinical Medicine, 137, 157 Clinical trial, 10, 11, 13, 105, 137, 138, 159 Cloning, 134, 137 Coagulation, 134, 137, 166 Coenzyme, 133, 137 Cofactor, 137, 158 Colitis, 82, 83, 137, 149 Colloidal, 137, 163 Complement, 137, 138 Complementary and alternative medicine, 43, 55, 138 Complementary medicine, 43, 138 Computational Biology, 105, 138 Concomitant, 75, 138 Congestion, 76, 138, 143 Connective Tissue, 133, 138, 144, 151, 160 Consciousness, 131, 138 Constipation, 14, 66, 80, 82, 83, 84, 138, 149 Constitutional, 84, 138 Constriction, 138, 166 Consultation, 8, 31, 138 Consumption, 4, 5, 64, 73, 111, 138, 160 Contact dermatitis, 45, 138 Contractility, 66, 138 Contraindications, ii, 138

Index 169

Control group, 11, 138 Controlled study, 16, 138 Coronary, 10, 139, 151, 152 Coronary Disease, 10, 139 Coronary Thrombosis, 139, 151, 152 Coronary Vessels, 139 Cortical, 139, 143 Cortisone, 139, 140 Curative, 139, 164 Cutaneous, 138, 139 Cyclic, 135, 139, 156, 164 Cytochrome, 137, 139 Cytoplasm, 133, 136, 139, 142, 145, 153 D Databases, Bibliographic, 105, 139 Deamination, 139, 165 Decarboxylation, 139, 146 Dendrites, 139, 153 Dentifrices, 130, 139 Dermal, 65, 139 Dermatitis, 46, 139 DES, 44, 140 Desquamation, 140, 152 Deuterium, 140, 147 Dexamethasone, 45, 140 Diabetes Mellitus, 48, 59, 140, 145, 146 Diagnostic procedure, 57, 93, 140 Diaphragm, 140, 146 Diarrhea, 14, 80, 82, 136, 140, 143, 149 Dietary Fats, 140, 150 Diffusion, 140, 148 Digestion, 73, 79, 81, 82, 83, 84, 130, 133, 134, 140, 141, 148, 150, 155, 162 Digestive system, 80, 81, 140, 145 Digestive tract, 72, 79, 81, 133, 140, 161 Dilatation, 140, 157 Dimethyl, 140, 161 Diploid, 140, 156 Direct, iii, 13, 63, 65, 85, 97, 137, 140, 141, 159 Disease Progression, 15, 140 Distal, 70, 140, 145, 158 Distention, 63, 65, 140 Diuresis, 135, 140, 164 Diurnal, 135, 140 Dopamine, 140, 151 Dosage Forms, 58, 68, 141 Drive, ii, vi, 8, 10, 37, 85, 91, 93, 116, 118, 141 Drug Interactions, 4, 81, 98, 99, 114, 141 Duct, 131, 141, 143, 160

Duodenal Ulcer, 27, 32, 43, 61, 66, 80, 141, 153 Duodenum, 70, 133, 141, 142, 144, 155, 162 Dyes, 133, 141, 144, 153 Dyspepsia, 6, 8, 9, 17, 20, 22, 28, 31, 34, 35, 44, 66, 69, 74, 80, 84, 115, 141, 148 Dysphagia, 10, 21, 73, 85, 141 Dysplasia, 14, 141 E Edema, 138, 141 Effector, 129, 137, 141, 156 Efficacy, 3, 12, 16, 18, 25, 44, 45, 47, 141 Elasticity, 132, 141 Electrolyte, 141, 149, 157, 162 Electrons, 132, 133, 141, 149, 154, 159 Ellagic Acid, 66, 141 Emboli, 142, 166 Embolism, 142, 158, 166 Embolization, 142, 166 Embryo, 58, 142 Empiric, 8, 142 Endoscope, 142 Endoscopic, 11, 12, 15, 30, 67, 95, 142, 143 Endoscopy, 5, 8, 10, 11, 30, 31, 34, 47, 88, 89, 95, 116, 142 Environmental Health, 104, 106, 142 Enzymatic, 135, 136, 138, 142, 146 Enzyme, 7, 14, 72, 137, 141, 142, 149, 150, 155, 156, 165, 166 Eosinophils, 65, 142, 146, 150 Epidemic, 9, 142 Epidemiological, 9, 142 Epidermal, 67, 142 Epidermal Growth Factor, 67, 142 Epidermis, 133, 142 Epigastric, 28, 142, 154 Epinephrine, 141, 142, 154 Epithelial, 12, 67, 129, 140, 142, 143 Epithelial Cells, 142, 143 Epithelium, 11, 143, 144 Eructation, 135, 143 Erythema, 138, 143 Erythrocytes, 131, 143 Esophageal Manometry, 6, 9, 89, 116, 143 Esophageal Ulcer, 66, 143 Esophagitis, 4, 6, 8, 9, 10, 11, 15, 20, 31, 34, 60, 63, 65, 66, 67, 80, 81, 85, 95, 115, 143, 145 Esophagoscopy, 6, 143 Esophagram, 133, 143 Eucalyptus, 66, 141, 143 Evacuation, 138, 143, 144

170 Heartburn

Evoke, 143, 162 Excipients, 58, 143 Excitatory, 75, 143, 145 Excrete, 132, 143, 149 Exocrine, 143, 154 Exogenous, 61, 129, 134, 143 Extracellular, 138, 143, 161 Extrapyramidal, 70, 141, 143 F Family Planning, 105, 143 Famotidine, 28, 31, 38, 52, 63, 64, 68, 69, 95, 143 Fat, 7, 20, 92, 117, 134, 136, 142, 143, 150, 154, 160, 163 Fatigue, 80, 82, 143 Fecal Incontinence, 14, 144 Feces, 138, 144, 162 Fistula, 34, 144 Flatulence, 64, 144 Flatus, 144 Flavoring Agents, 143, 144 Food Coloring Agents, 76, 144 Forearm, 134, 144 Fundus, 73, 144 G Gallate, 46, 144 Gallbladder, 81, 82, 129, 134, 140, 144 Gallstones, 80, 81, 83, 85, 134, 144 Ganglia, 129, 144, 153 Gas, 58, 64, 80, 82, 83, 130, 131, 133, 140, 143, 144, 147, 148, 149, 163, 165 Gastric Acid, 5, 6, 9, 34, 65, 68, 69, 80, 137, 144, 153 Gastric banding, 71, 144 Gastric Emptying, 6, 66, 70, 72, 75, 144 Gastric Fundus, 63, 73, 144 Gastric Juices, 89, 144, 155 Gastric Mucosa, 67, 80, 144, 155 Gastrin, 137, 144, 147 Gastritis, 6, 13, 48, 61, 62, 70, 145 Gastroenterologist, 88, 145 Gastrointestinal tract, 11, 13, 17, 38, 61, 64, 70, 75, 85, 144, 145, 149, 161 Gene, 84, 134, 145, 156 Genetic Code, 145, 154 Genetics, 12, 93, 145 Genital, 133, 137, 145 Ginger, 47, 52, 145 Ginkgo biloba, 44, 145 Gland, 129, 139, 145, 154, 161, 162, 163, 164 Glucocorticoid, 140, 145

Glucose, 14, 66, 133, 134, 136, 140, 145, 146 Glucose Intolerance, 140, 145 Glutamate, 76, 145 Governing Board, 145, 157 Grafting, 145, 148 Granulocytes, 65, 145, 166 Growth, 67, 131, 135, 136, 142, 146, 151, 152, 156, 164 H Haploid, 146, 156 Headache, 49, 135, 146 Health Promotion, 88, 146 Heart attack, 81, 146 Hemodialysis, 135, 146, 149 Hemoglobin, 14, 131, 143, 146 Hemoglobin A, 14, 146 Hepatic, 47, 146 Heredity, 145, 146 Hernia, 60, 85, 117, 146 Hiatal Hernia, 6, 33, 62, 73, 81, 85, 88, 110, 115, 116, 118, 146 Histamine, 5, 8, 68, 72, 94, 98, 136, 143, 146, 147, 153, 159 Histamine Agonists, 146 Histamine Antagonists, 5, 146 Histidine, 146, 147 Hoarseness, 7, 88, 95, 147, 149 Homogeneous, 12, 132, 147, 156 Hormone, 139, 140, 142, 144, 147, 151, 160, 164 Hydrochloric Acid, 62, 129, 147 Hydrogen, 67, 75, 129, 131, 133, 135, 140, 147, 150, 152, 153, 154, 158 Hydrogen Peroxide, 147, 150 Hydrolysis, 66, 134, 147, 157, 158 Hydroxides, 13, 147 Hyperbilirubinemia, 147, 149 Hypercholesterolemia, 46, 49, 147 Hyperplasia, 65, 147 Hypersecretion, 9, 147 Hypersensitivity, 21, 147, 160 Hypertrophy, 147 I Ibuprofen, 64, 117, 147 Id, 39, 47, 110, 119, 124, 126, 147 Idiopathic, 14, 147 Imidazole, 146, 147, 159 Immune response, 129, 132, 139, 147, 163, 165 Immune system, 76, 147, 166 Immunodeficiency, 116, 147 Immunodeficiency syndrome, 116, 147

Index 171

Implantation, 71, 148 In vitro, 11, 12, 148 In vivo, 12, 148 Incision, 148 Incompetence, 145, 148 Indicative, 14, 81, 114, 148, 155, 165 Indigestion, 8, 27, 29, 32, 39, 45, 58, 64, 68, 69, 73, 75, 80, 81, 82, 83, 84, 85, 88, 114, 148, 149 Infarction, 148 Infection, 8, 49, 59, 80, 117, 147, 148, 150, 153, 160, 163, 165, 166 Infiltration, 65, 148 Ingestion, 6, 19, 61, 63, 64, 65, 68, 76, 148, 156 Inlay, 148, 160 Inorganic, 67, 130, 147, 148, 150, 152 Insight, 14, 148 Intercellular Junctions, 11, 148 Intermittent, 44, 66, 148 Intestinal, 14, 62, 65, 66, 79, 80, 83, 85, 136, 148, 150, 152 Intestine, 14, 73, 134, 148, 149, 155 Intoxication, 135, 148, 166 Intracellular, 135, 148, 151, 157 Invasive, 13, 30, 148 Involuntary, 144, 148, 153 Ions, 11, 133, 136, 141, 147, 148 Irritable Bowel Syndrome, 44, 49, 82, 149 Isoenzyme, 75, 149 Isotonic, 71, 149 J Jaundice, 81, 147, 149 K Kb, 104, 149 Kidney Disease, 88, 104, 111, 118, 135, 149 Kidney Failure, 13, 149 Kidney Failure, Acute, 149 Kidney Failure, Chronic, 149 Kinetic, 14, 149 L Lactose Intolerance, 9, 76, 149 Large Intestine, 140, 148, 149, 159, 161 Laryngitis, 6, 114, 149 Larynx, 149, 150 Lesion, 12, 150, 161, 165 Lethal, 6, 150 Leukocytes, 133, 142, 145, 150, 153 Library Services, 124, 150 Ligaments, 139, 150 Linkage, 9, 150 Lipase, 72, 150

Lipid, 59, 132, 150 Lipid Peroxidation, 59, 150 Liver, 33, 82, 85, 129, 133, 134, 140, 144, 146, 150, 165 Localization, 12, 150 Localized, 12, 148, 150, 156, 161, 165 Locomotion, 150, 156 Loop, 71, 146, 150 Lower Esophageal Sphincter, 6, 9, 12, 17, 70, 85, 88, 114, 115, 116, 118, 145, 150, 164 Lumen, 11, 150 Lymphatic, 148, 150, 151, 156 M Magnesium Hydroxide, 68, 150 Malabsorption, 81, 150 Malaise, 70, 150 Malignancy, 10, 150 Malignant, 11, 66, 129, 132, 151 Malignant tumor, 66, 151 Manifest, 85, 151 Mastication, 67, 151 Meat, 80, 113, 140, 151 Medial, 132, 151 Mediate, 141, 151, 159 Medical Assistance, 95, 151 Medicament, 62, 151 MEDLINE, 105, 151 Membrane, 136, 138, 150, 151, 152, 154, 156, 158 Membrane Proteins, 151, 158 Memory, 131, 151 Meninges, 136, 151 Mesenchymal, 142, 151 Metaplasia, 15, 151 Metastasis, 151 Metastatic, 46, 151 Metoclopramide, 21, 53, 70, 98, 117, 151 MI, 9, 68, 128, 151 Microbe, 151, 164 Microbiology, 129, 133, 151 Microorganism, 137, 151, 166 Microscopy, 12, 152 Mobility, 60, 152 Modification, 5, 89, 114, 152, 159 Modulator, 61, 152 Molecular, 105, 107, 134, 138, 152 Molecule, 130, 132, 133, 137, 141, 147, 152, 154, 159 Molting, 58, 152 Monitor, 118, 152 Morphine, 75, 152, 153, 154

172 Heartburn

Morphological, 142, 152 Morphology, 12, 152 Motility, 6, 14, 21, 29, 66, 75, 152, 161 Motion Sickness, 152, 153 Motor Activity, 63, 65, 152 Mucins, 152, 160 Mucosa, 9, 12, 63, 65, 67, 144, 152 Mucosal Lining, 85, 152 Mucus, 67, 152 Myenteric, 75, 152 Myocardial infarction, 139, 151, 152, 166 Myocardial Ischemia, 139, 152 Myocardium, 151, 152, 153 N Narcotic, 152, 153 Nausea, 7, 14, 59, 70, 71, 74, 75, 76, 80, 81, 95, 132, 141, 148, 153, 154, 165 NCI, 1, 103, 137, 153 Necrosis, 148, 151, 152, 153 Need, 3, 69, 74, 79, 82, 84, 87, 93, 94, 120, 153 Nerve, 14, 131, 139, 153, 157, 161, 162, 164 Nervous System, 136, 153, 163 Neuromuscular, 129, 153 Neuromuscular Junction, 129, 153 Neuronal, 14, 153 Neurons, 14, 75, 139, 143, 144, 153, 163 Neuropathy, 14, 75, 133, 153 Neutralization, 4, 13, 68, 153 Neutrons, 130, 153, 159 Neutrophils, 146, 150, 153 Nicotine, 117, 153 Nizatidine, 16, 20, 30, 54, 68, 95, 153 Nonulcer Dyspepsia, 81, 153 Norepinephrine, 14, 141, 154 Nucleic acid, 59, 145, 154 Nucleus, 133, 136, 139, 140, 142, 153, 154, 158 O Occult, 15, 154 Odynophagia, 10, 85, 154 Oesophagitis, 9, 23, 25, 28, 30, 44, 154 Ointments, 141, 154 Oliguria, 149, 154 Opium, 152, 154 Osmolality, 32, 39, 154 Osmoles, 154 Osmotic, 154 Otolaryngology, 15, 154 Overweight, 9, 39, 73, 115, 128, 154 Oxidation, 59, 129, 132, 134, 139, 150, 154

P Palliative, 154, 164 Pancreas, 85, 129, 140, 150, 154, 155 Pancreatic, 81, 145, 155 Pancreatic Juice, 145, 155 Panic, 6, 155 Paraneoplastic syndrome, 14, 155 Pathogenesis, 11, 155 Pathologic, 24, 134, 139, 147, 155 Patient Education, 89, 94, 112, 114, 116, 117, 118, 122, 124, 128, 155 Pepsin, 65, 68, 137, 155 Pepsin A, 137, 155 Peptic, 6, 13, 31, 63, 65, 68, 80, 81, 110, 115, 155 Peptic Ulcer, 6, 13, 31, 68, 80, 81, 110, 115, 155 Peptide, 14, 155, 157, 158 Perception, 20, 155, 160 Perfusion, 12, 34, 155 Peristalsis, 46, 155 Peritoneal, 85, 155 Peritoneum, 155 Pharmaceutical Preparations, 69, 136, 155 Pharmaceutical Solutions, 141, 156 Pharmacodynamic, 143, 156 Pharmacokinetic, 156 Pharmacologic, 35, 131, 156, 164 Pharynx, 145, 156 Phosphodiesterase, 75, 156 Phospholipids, 143, 156 Phosphorus, 13, 135, 156 Physiologic, 63, 130, 149, 156, 159 Physiology, 6, 8, 14, 33, 73, 80, 81, 85, 88, 117, 129, 156 Pigments, 134, 136, 156 Pilot study, 15, 156 Plants, 66, 130, 137, 145, 152, 154, 156, 164, 165 Plasma, 14, 136, 145, 146, 149, 156 Plasticity, 14, 156 Platinum, 150, 156 Plexus, 75, 156 Poisoning, 148, 153, 156 Polymers, 61, 157, 158 Polypeptide, 142, 155, 157 Port, 71, 157 Port-a-cath, 157 Posterior, 131, 154, 157 Postprandial, 16, 21, 32, 38, 39, 75, 157 Postsynaptic, 14, 157, 163 Potassium, 157

Index 173

Practice Guidelines, 106, 157 Precancerous, 5, 6, 8, 95, 157 Precursor, 6, 66, 129, 141, 142, 154, 157 Premalignant, 10, 157 Prenatal, 142, 157 Presynaptic, 14, 157, 163 Prevalence, 7, 9, 15, 23, 27, 31, 45, 66, 70, 89, 157 Probe, 4, 11, 157 Progression, 131, 157 Progressive, 132, 146, 149, 153, 157 Projection, 154, 157 Prokinetic Drugs, 88, 157 Prone, 76, 89, 158 Prone Position, 89, 158 Prophylaxis, 158, 166 Proportional, 154, 158 Prospective study, 33, 158 Prosthesis, 63, 158 Protein C, 158, 165 Protein S, 84, 134, 145, 158 Proteins, 13, 59, 76, 131, 132, 136, 137, 151, 152, 155, 156, 157, 158, 161, 164, 165 Proton Pump, 5, 8, 9, 10, 13, 33, 68, 69, 72, 88, 89, 95, 158 Proton Pump Inhibitors, 5, 8, 10, 33, 69, 88, 89, 95, 158 Protons, 130, 147, 158, 159 Proximal, 140, 157, 158 Public Assistance, 151, 158 Public Policy, 105, 158 Publishing, 6, 16, 60, 74, 79, 80, 158 Pulmonary, 134, 138, 149, 158, 163, 166 Pulmonary Artery, 134, 158 Pulmonary Edema, 149, 158 Pulmonary Embolism, 158, 166 Pulse, 152, 158 Pyloric Stenosis, 14, 159 Pyramidal Tracts, 143, 159 Pyrosis, 34, 59, 63, 65, 159 Q Quality of Life, 4, 5, 9, 13, 14, 20, 22, 30, 31, 159 R Race, 64, 159 Radiation, 63, 65, 159, 166 Radioactive, 147, 148, 159 Randomized, 4, 13, 17, 20, 27, 28, 30, 38, 44, 45, 46, 141, 159 Randomized clinical trial, 13, 159 Ranitidine, 3, 4, 7, 16, 17, 18, 21, 26, 28, 29, 30, 31, 33, 38, 39, 54, 68, 95, 159

Reagent, 147, 159 Receptor, 8, 10, 34, 68, 69, 72, 88, 89, 98, 129, 132, 141, 143, 153, 159, 161 Rectum, 132, 134, 140, 144, 149, 159 Recur, 24, 32, 159 Recurrence, 8, 30, 44, 159 Redux, 24, 159 Refer, 1, 137, 145, 150, 153, 159 Refraction, 159, 162 Refractory, 5, 32, 159 Regimen, 4, 46, 141, 159 Regurgitation, 4, 15, 33, 61, 63, 65, 68, 112, 115, 145, 146, 159 Relapse, 12, 31, 38, 160 Reliability, 31, 160 Remission, 159, 160 Resected, 11, 160 Respiration, 152, 160 Restoration, 67, 160 Retrospective, 15, 160 Retrospective Studies, 15, 160 Retrosternal, 61, 160 Rheumatism, 45, 147, 160 Rheumatoid, 45, 160 Rheumatoid arthritis, 45, 160 Rigidity, 156, 160 Risk factor, 7, 15, 24, 88, 117, 158, 160 S Saliva, 61, 160 Salivary, 67, 140, 160, 163 Salivary glands, 67, 140, 160 Schizoid, 160, 166 Schizophrenia, 49, 160, 166 Schizotypal Personality Disorder, 160, 166 Scleroderma, 9, 14, 49, 110, 132, 161 Sclerosis, 132, 161 Screening, 8, 11, 15, 34, 137, 161 Secretion, 10, 67, 68, 75, 129, 137, 142, 143, 146, 147, 152, 153, 159, 161 Self Administration, 161 Self Care, 6, 161 Self Medication, 3, 161 Sensor, 33, 71, 161 Serotonin, 129, 161 Serum, 137, 149, 161 Shedding, 140, 152, 161 Side effect, 10, 70, 72, 73, 75, 94, 95, 97, 129, 161, 164 Signs and Symptoms, 160, 161 Simethicone, 64, 69, 161 Small intestine, 14, 134, 141, 147, 148, 161

174 Heartburn

Smooth muscle, 14, 75, 135, 146, 152, 161, 163 Social Environment, 159, 161 Sodium, 13, 58, 68, 98, 161, 162 Sodium Bicarbonate, 68, 98, 162 Solvent, 154, 156, 162 Soma, 162 Somatic, 44, 162 Spastic, 49, 149, 162 Specialist, 8, 119, 162 Species, 13, 142, 145, 159, 162, 163, 164, 165, 166 Spectrometer, 14, 162 Spectrum, 4, 162 Sphincter, 8, 9, 72, 95, 115, 150, 162 Spinal cord, 136, 151, 153, 159, 162 Stasis, 74, 162 Sternum, 68, 160, 162 Stimulant, 135, 146, 162 Stimulus, 22, 138, 141, 162, 164 Stoma, 71, 162 Stomachic, 72, 162 Stool, 149, 162 Stress, 7, 72, 73, 80, 82, 111, 115, 117, 149, 153, 160, 162 Stricture, 6, 66, 88, 162 Subacute, 148, 163 Subclinical, 148, 163 Subcutaneous, 59, 141, 163 Submaxillary, 142, 163 Subspecies, 162, 163 Substance P, 161, 163 Supine, 63, 65, 163 Supplementation, 44, 45, 163 Surfactant, 61, 163 Survival Rate, 15, 163 Suspensions, 62, 163, 165 Sympathomimetic, 141, 142, 154, 163 Symptomatic, 9, 19, 47, 61, 62, 113, 163 Symptomatic treatment, 61, 62, 163 Synaptic, 153, 163 Synaptic Transmission, 153, 163 Systemic, 98, 134, 142, 148, 161, 162, 163, 165, 166 T Theophylline, 94, 163 Therapeutics, 3, 4, 16, 17, 19, 20, 21, 24, 27, 28, 29, 30, 31, 33, 35, 45, 99, 164 Thermal, 12, 153, 164 Thorax, 129, 164 Threshold, 13, 14, 164 Thrombosis, 158, 164

Thyroid, 135, 164 Tips to control heartburn, 88, 114, 164 Tonic, 162, 164 Tonicity, 149, 164 Tonus, 72, 164 Topical, 133, 147, 162, 164 Toxic, iv, 67, 135, 153, 164 Toxicity, 46, 59, 74, 141, 153, 164 Toxicokinetics, 164 Toxicology, 106, 164 Toxins, 132, 148, 164 Transfection, 134, 164 Transmitter, 129, 141, 154, 164 Transplantation, 45, 149, 164 Trauma, 143, 146, 153, 164 Trees, 143, 165 Tuberculosis, 138, 165 U Ulcer, 6, 8, 66, 70, 80, 83, 84, 117, 141, 143, 154, 155, 165 Ulceration, 88, 165 Unconscious, 147, 165 Urea, 8, 149, 165 Urea Breath Test, 8, 165 Uremia, 149, 165 Urinary, 154, 165 Urine, 132, 134, 140, 142, 149, 154, 165 Uterus, 144, 165 V Vaccines, 130, 165 Vagina, 140, 165 Vascular, 44, 131, 148, 165 Vascular Resistance, 131, 165 Vasodilator, 141, 146, 165 VE, 27, 28, 31, 165 Veins, 134, 139, 156, 165 Venous, 158, 165, 166 Venous Thrombosis, 165, 166 Ventricular, 131, 165 Veterinary Medicine, 105, 165 Virulence, 133, 164, 165 Virus, 116, 165 Viscera, 162, 166 Visceral, 133, 155, 166 Vitro, 13, 166 Vivo, 14, 166 W Warfarin, 94, 166 Wheezing, 7, 76, 95, 166 White blood cell, 132, 150, 152, 166 Withdrawal, 71, 166

Index 175

X Xenograft, 131, 166

X-ray, 133, 143, 166

176 Heartburn

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